COMMISSIONING
but if you don’t get primary and community care and prevention and self-care right then the system is unsustainable.
“Being able to invest in the early part of the pathways is vital. That’s really difficult, though, if your commissioning responsibilities are limited.”
Under current legislation, Liverpool CCG has developed a separate contractual arrangement with its general practices that has seen an improvement in access, a decrease in unplanned care usage and has seen controlled levels of GP referrals with clinicians referring along evidence-based pathways.
But there have been concerns raised nationally about conflicts of interest within CCGs. NHS England has also stated that while guidance on this is already in place it is “to be strengthened in recognition that co-commissioning is likely to increase the range and frequency of real and perceived conflicts of interest”.
A national framework for conflicts of interest in primary care co-commissioning is to be published as statutory guidance in December 2014.
Dr Bowers said: “Anything that can assure the public and will assure the centre that CCGs aren’t playing a game where they feather their own nest, and the nest of those GP members
of the governing bodies, is an absolutely good thing.
“At Liverpool we set up a separate panel of our non-executives, our non-GP clinicians, and some of our managers, where any decision goes to when the governing body might make a decision about a direction of change. If that involves an investment in general practice, we have an internal, but non-GP panel of managers.”
Delivering for local health economies
NHE was told that there is no secret in the clinical evidence that the best healthcare systems across the world are those that invest heavily in the front-end of pathways.
“You cannot get around the NHS conundrum without investing in primary and community care. We have just got to deal with that conflict of interest,” said Dr Bowers. “There will always be perceived conflict of interest and there will always be challenges from groups in the public, but if you’re transparent and honest about it I don’t believe it is a big jump from where we are now.”
Asked about the relationship between CCGs and Health and Wellbeing Boards (HWBs), he noted that historically the two come from different cultures that have been a world apart. “But, actually, the challenges facing local government, particularly in the core cities and
northern cities, are identical if not more acute than the challenges facing the NHS. Too many punters; not enough cash,” he said.
Recently shadow health secretary Andy Burnham suggested that if Labour won the next election CCGs could be morphed into the operational arms of HWBs – moving ultimate responsibility for NHS commissioning to local government.
But Dr Bowers noted that any further changes, especially ones that decrease the role of clinicians in commissioning of health services, would be a massive retrograde step.
“There has been a lot of expertise gained since CCGs came about and I think there is a risk to health economies of losing that expertise if you take away the accountability and statutory nature of the bodies that have been created,” he said.
“This would be a massive opportunity lost because CCGs are starting to cut through a lot of the bureaucracy with a clear clinical vision delivering a really good consensus leadership across the health economy.”
Dr Simon Bowers
TELL US WHAT YOU THINK
opinion@nationalhealthexecutive.com
national health executive Nov/Dec 14 | 41
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100