MANAGING COMMISSIONING PCTS
When labour abolished GP fundholding in 1997, health authorities were replaced by primary care groups which then formed PCTs. In 2004 practice based commissioning (PBC) was introduced and practices were given indicative budgets along with data on the volume of services their patients were using, thus allowing them once more to become involved with commissioning. PBC struggled in the early years as a lack of incentive meant GP practices were slow to participate. At this point, rather than offering incentive, it seemed that the solution lay in recruiting
of a population’s health needs. A CSS can specialise in one particular activity or product, it could offer a “one stop shop” service, or anything in between. CSSs will not be able to make actual commissioning decisions however, the CSSs will be able to provide support or advice to enable the CCGs and NHS CB to make better informed decisions. The idea is that each CCG will be able to choose from a variety of organisations to create a model of service which best meets their needs, and the needs of its population. For example, a CCG could choose to run all its support functions in-
“The legacy left by the PCTs will very much depend on how successful they were, which in turn links directly to how good their personnel were, and how good their relationship was with their GPs ”
and how much those on the new CCG Board will be able implement in the way of changes. Undoubtedly, GPs will be pleased to
have experienced support in the running of their CCGs as they are, after all, keen to practice medicine, not run bureaucratic organisations. But it is to be hoped that some of the layers of management are now a thing of the past. Long before the PCTs evolved, GPs were commissioning services. Indeed, many remember the days of GP fundholding very positively. Under GP fundholding, GPs held real budgets with which they purchased primarily non-urgent elective and community care for patients; they had the right to keep any savings and had the freedom to deliver new services. Some practices went a step further to form consortia, creating larger organisations to pool financial risk and share resources. Some of those GPs involved in fundholding now find themselves sitting on clinical commissioning groups (CCGs). They bring a wealth of expertise to the CCG table as a result.
numerous layers of managers, within the PCT, to try and do the work on the GP practices behalf. Undoubtedly, by the time the PCTs cease to exist some of these managers will have moved on to pastures new. It is to be hoped that those more expendable will have moved on whilst those skilled in commissioning are retained. When the White Paper was first announced there was a flurry of activity as some key, valued personnel jumped ship straight away, leaving a fear amongst GPs that they would be left with those less valuable members of staff within their CCG. Another fear is that those members of the PCT who have elected to stay on till the end, may well reappear in another guise in one of the CCG support organisations.
From April 2013, CCGs and the NHS Commissioning Board will be responsible for the whole commissioning process. Like all organisations, they will also require services like HR, IT and administrative support. To allow them to concentrate on improving clinical care pathways and improving efficiency, they will be able to contract with other organisations, in order for these new organisations to carry out some of the commissioning functions for them. These organisations are called commissioning support services (CSSs). The commissioning support involves a wide variety of activities from payroll services for staff, to complex forecasting
house, if they have the necessary skills and are big enough to make it cost-effective. If it is a small CCG, it could band together with others and buy all its services from a “one stop shop” CSS to benefit from economies of scale. For some a combination of the two will work best. By the nature of their expertise, the
CSSs could potentially attract all those from the PCT who could not find jobs directly in the CCG, particularly when it comes to the commissioning support units (CSUs). All organisations contracted to provide services for CCGs or the NHS CB are given the blanket term “commissioning support service”. Some of these will develop from existing PCTs and will remain part of the NHS for a transition period. These will be called commissioning support units (CSUs) to distinguish them from the wider CSS marketplace. Either via TUPE or recruitment it is possible that many ex-PCT staff will re-locate to these organisations.
The legacy left by the PCTs will very much depend on how successful they were, which in turn links directly to how good their personnel were, and how good their relationship was with their GPs. It is to be hoped that good practice and good personnel are recruited into CCGs, and that re-invention does not take place. Otherwise many will be left wondering what the point of this vast exercise was.
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