IN ACTION INTERVIEW


bulk of your resources trying to performance-manage your major players. We took a very different approach here. We thought: ‘Well actually, rather than do it, let’s just lay it out to our economy.’” He continues: “This wasn’t about the acute provider, or community provider, primary care or county council/social services separately, because it didn’t matter. What mattered was the patient and how we all thought about how we wanted to manage particular conditions.” If you try and do it individually, he says, “it just becomes laborious, difficult and everybody pulls apart by the very nature of the way we work”. What Chorley and South Ribble and Greater Preston wanted to do differently was share the load. “So we’re in a very facilitative role, rather than commissioning in terms of contracting and performance management, although we do all those things,” Dr Bangi comments. “What we do is we sit down and say: ‘This is how it’s going to work’ and the contracts support the agreements.” The clinical senate, therefore, becomes the place where the commissioning strategies are agreed. “The senate holds everybody to account, including us,” Dr Bangi explains. The result is what he calls “an empowered health economy”, concluding: “This isn’t about a provider who’s only interested in themselves... this is us all working for the benefit of our population.”


To facilitate this, Chorley and South Ribble and Preston CCGs share one management team, with one resource, a single accountable officer and mostly joint meetings. There are some staff who support Greater Preston and others who support Chorley South Ribble, but the majority work across both. “A lot of work we do, we manage it collectively across the economy,” says Dr Bangi. “So if you look at our dementia work, there are some people that work for the dementia team that belong to Lancashire Teaching Hospital, some people work for the community provider, and there’s one or two members from the county council and some of our team. We are trying to empower the whole health economy to take responsibility over what we need to do and what outcomes we’re all looking for.” They work together in such a close fashion, they could almost be mistaken for one CCG, though Dr Bangi is adament they are not: “There’s a lot of influence in having two CCGs.”


GOOD ADVICE


So how best should CCGs move toward collaboration? “CCGs need to be very astute in understanding what role it is they’re playing,” says Dr Bangi. “Most economies have some very powerful players and if you’re not careful the commissioner ends up facilitating a very ‘us and them’ approach and you spend the


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