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Making commissioning a success


2 May 2012

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If one were to look for a sporting analogy for the Health and Social Care Bill the most appropriate match might be the Grand National. Lots of tipsters commented on the runners and riders before the event, participants milling around on the start line jockeying for position, the odd false start or two thrown in before the tape goes up and then everyone rushing off towards the finish – knowing full well that many of them will not make it to the finish line.

If one were to look for a sporting analogy for the Health and Social Care Bill the most appropriate match might be the Grand National. Lots of tipsters commented on the runners and riders before the event, participants milling around on the start line jockeying for position, the odd false start or two thrown in before the tape goes up and then everyone rushing off towards the finish – knowing full well that many of them will not make it to the finish line.

CCGs were originally told that Commissioning would not be a top-down process, size and structure would be subject to local circumstances. That position has steadily changed with the size and shape now being heavily influenced by budget constraints and links to local authorities, resulting in CCGs no longer being the small, cosy, locality groups than many GPs were anticipating.

The most recent indication that there will undoubtedly be some top-down management is with the imposition of a national finance system for CCGs, funded by the National Commissioning Board. Now that particular decision, in isolation, is probably no bad thing however how many other top-down decisions might we expect in the near future?

It is very clear that the government genuinely does believe that the CCGs can improve the quality of commissioning, however they are very clear that this must be achieved within budget. To quote Sir David Nicholson, ‘we must deliver “great outcomes for patients within the money that we have got”’. As part of this process phrases like “Reconfiguration”, “buy in” and “service change backed by local clinicians” are bandied about, generally followed in the next breath by references to the ‘performance management’ of GPs.

Getting all GPs, not just the CCG Board, to actively take part in making Commissioning a success is something that the Government was mindful of from the outset. Their original plan was to top slice funds from existing GP contracts and hold them in a pot labelled ‘Quality Premium’. If a CCG stayed within budget then it would get the money back to distribute to practices appropriately. This plan got shot down by the argument that it was unethical to award GPs for limiting referrals, so at the moment the Government appears to be scratching their heads trying to come up with a workable plan B. Doubtless plan B will on first glance look like a carrot, however the chances are that closer inspection may well reveal that it is actually a club with a nail in it, sprayed orange and with some greenery tied to the top.

We are also seeing Financial Trusts being enthusiastic about the ‘leadership opportunities’ that the new world offers. This could lead to trusts merging to improve efficiencies however it seems that they are concerned about the ‘complications’ of contracts. The merger of Trusts is unlikely to increase local competition and that, together with an apparent distaste for contracts which actually hold Trusts to account, will mean CCGs will not find it easy to make significant changes quickly.

 

Bob Senior is Chairman of AISMA and head of RSM Tenon's national Medical Services team.  AISMA, the Association of Independent Specialist Medical Accountants is the leading association for medical accountants in the UK and its 77 members between them act for just over one third of UK practices.

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