COMMISSIONING
Dr Michael Dixon, who chairs the NHS Alliance, examines the extent to which Clinical Commissioning Groups have ‘had their wings clipped’ by the amended NHS reforms.
T
he ‘Pause’ has ended, the NHS Fu- ture Forum have reported and the Government has responded. Meanwhile, the Health & Social Care Bill continues to go through Parliament and heads for the Lords. Has anything changed?
Clinical Commissioning Groups (CCGs), previously known as GP Commissioning Consortia, have felt more than a little left out. Their future has been discussed by the NHS Future Forum, which consisted of many more managers and secondary care clinicians than GPs. The new CCGs will have to have a nurse and consultant on their governing board and their plans (and any changes to them) ratifi ed by the Health & Wellbeing Board with clinical senates and clinical networks adding another lot of seeming ‘nosey parkers’, who can quash their plans. What happened to the Health White Paper’s promise of commissioning groups having “assumed responsibility” rather than “earned autonomy”? Are we still on track for an NHS whose behaviour is dictated not by high-minded centralism but from the frontline consulting room? In short, have CCGs had their wings clipped?
For most commentators the answer to that 24 | national health executive Jul/Aug 11
Below: Sir David Nicholson,
Chief Executive of the NHS
question is a resounding ‘yes!’. It is an im- pression that is not much altered by the widely-leaked plans of the new National Commissioning Board. While every Tom, Dick and Harry was commenting on CCGs – who should be on their Board, what they should do and to whom they should be ac- countable – the mandarins at the centre of the NHS quietly drew up their own draft proposals for the new National Commis- sioning Board, which have been issued for consultation. Those plans look very much like a Department of Health ‘off-the-shelf’ model. The Board will have the usual Medi- cal Director (presumably as usual from sec- ondary care), Nursing Director and leads in the fi ve areas of Government policy.
Nowhere in the plans, as far as I can see, is
there more than tokenistic recognition that the rules of the game have changed. There is no direct connection to CCGs and more than a hint that they will be sorted through born-again PCT clusters acting more or less as Strategic Health Authorities do at present. The National Commissioning Board looks like ‘NHS mission control’ and not the promised ‘support for clinical com- missioning groups’. Why on earth aren’t they featured on it?
Phoney war
You may say that all this sounds depress- ing. I will admit to having been in a deep depression over the past two months. I am past that now because it is now abundant- ly clear that things have changed and are about to change utterly.
The ‘Pause’ will, in retrospect, be seen to have been a ‘phoney war’. Idealists, some well-meaning and some full of wind, have been battling it out, while the solutions have been staring us all in the face. Those solutions are simply about how we trans- fer appropriate services from secondary to primary care and how we de-professional- ise care and better enable individuals and
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