CCGs must commission for England’s whole population, not just for “those with sharp elbows,” conference hears

BMJ 2013; 346 doi: (Published 05 March 2013) Cite this as: BMJ 2013;346:f1466
  1. Matthew Limb
  1. 1London

Patients are being photographed in hospitals by their families because of “unprecedented” levels of anxiety about their care, a conference has heard.

Edna Robinson, managing director of NHS Clinical Commissioning Community, said this “spectacular loss of confidence” in the wake of the Francis inquiry would pose a huge challenge to new commissioning bodies.

She said that England’s primary care trusts (PCTs), which are being disbanded from 1 April, had plainly failed to connect with the public and assure the quality of care despite doing good work in other areas. The new Clinical Commissioning Groups (CCGs) now being set up would have to have the confidence to “walk the wards” and develop strong networks with communities, she said.

Robinson was speaking in London on 27 February at a Westminster Health Forum seminar about Clinical Commissioning Groups and local authorities managing the transition from PCTs.

She spoke of promising signs of collaboration between emerging CCGs and health and wellbeing boards. “But there is still a lot of anxiety about how the two different cultures [of the NHS and local government] will come together.”

She said she had worked closely with clinicians across the NHS in England and had compiled “soft intelligence” reports on a regular basis for the NHS Commissioning Board’s chief executive, Sir David Nicholson.

The conference of health experts discussed a range of matters facing commissioners, including concerns over risks to continuity of care resulting from transfer of responsibilities to new bodies and risks of fragmentation to the service.

Oliver Pritchard, a healthcare lawyer, said it was unclear how new commissioning bodies would approach service redesign and seek to integrate services when new procurement regulations would drive them to treat NHS providers as part of a competitive market.

Several experts spoke about opportunities to improve care quality and develop new services more attuned to patients’ needs rather than organisations’ traditional interests.

Bob Ricketts, director of NHS Provider Transition at the Department of Health, said it would be the job of commissioners under the new system to “challenge the status quo” to improve outcomes.

He said the biggest challenge for commissioning was to commission for a high quality NHS serving the entire population, “not just those with sharp elbows.” He said implementation of the QIPP (quality, innovation, productivity, and prevention) challenge set by the NHS to improve quality while making efficiency savings required nothing less than a transformation in the way services were delivered.

This meant more emphasis on prevention and better designed pathways helping people to manage chronic conditions; and some of the biggest challenges were in primary care rather than hospitals. “The reforms give us the opportunity to drive up quality and drive out unwarranted variation,” he said, adding, “If we crack QIPP and Francis through really bold commissioning we’ll have done patients a huge service.”

Jane Milligan, chief officer for NHS Tower Hamlets Clinical Commissioning Group, said anxieties over the challenges presented by fragmentation under the new system “keep me awake at night.”

Judith Smith, policy director for the Nuffield Trust, said PCTs could have used money available during years of growth in NHS expenditure to “take some of the tougher decisions about configuring services and shift resources out of secondary care.”


Cite this as: BMJ 2013;346:f1466

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