NHS changes: is Wiltshire's Clinical Commissioning Group being retired? Surely not - it's only six years oldThe latest changes to the organisation of the region's NHS mean that Wiltshire will become part of a much larger decision-making structure. This has left members of Wiltshire Clinical Commissioning Group (WCCG) needing to reassure MPs in the county that the 'Wiltshire voice' will still be heard on health care decisions.
When the Coalition Government was dealing with Andrew Lansley's idiosyncratic plans to revamp the NHS in England, the theory of the moment was clear - small was beautiful. Localism would see us right and calm fears that we were being ruled by over-mighty and distant organisations.
Out went Strategic Health Authorities and Primary Care Trusts. In came Clinical Commissioning Groups (CCGs) led - as it says on the tin - by local clinicians. At the outset, some Wiltshire GPs wanted really local decision-making, so pressed hard for the county to have three or four separate CCGs. They were persuaded that would be too costly.
As a compromise, in April 2013 the fully fledged Wiltshire CCG was launched - divided into three fairly separate 'localities'. Sarum, West Wilts and North & East Wilts (or NEW) 'localities' were created - each with its own committee, chairman and an attached senior CCG director.
Now, however, 'small' and 'local' are considered both too costly (as in not value for taxpayers pounds) and inefficient. Commissioning of health services needs, it is now claimed, to be done 'at scale'. With purpose in mind, that phrase has dropped the world 'large' - 'at scale' sounding less threatening than 'at large scale'.
So we have the Sustainability & Transformation Partnership (STP), which covers Bath & North East Somerset, Swindon and Wiltshire - BSW for short and more about it in the next article. Tracey Cox is now heading up the STP.
And we have another larger than Lansley grouping coming over the horizon: the three CCGs for those three STP areas are edging ever closer to merger or even full amalgamation.
Already the three CCGs have one Chief Executive - also Tracey Cox - with her own management team (coming very soon) and a single budget for running costs. An order from on high is cutting running costs for CCGs - which may be one reason for amalgamation?
This month she will be designing her scheme of staffing and will start interviewing to fill the new posts - probably with people already employed in the three CCGs. It is an uncertain time for the WCCG staff.
Quite what happens to the remaining or 'rump' CCGs is unclear. At present they still have responsibility for distributing the money Wiltshire gets from central NHS funds.
They will continue, we must presume, to commission those services for which they hold that funding. This includes treatment at the three acute hospitals that serve most Wiltshire patients.
In 2017-2018 the expenditure by all England's CCGs was £81.2billion - with running costs of £1.1billion or 1.4 per cent of their expenditure. Wiltshire CCG's allocation of funding for 2019/2020 is £718,950,000.
Across England, this sort of change in the CCG map is not entirely new. The 'Lansley landscape' began with 211 CCGs. Between April 2013 and April 2018 there were eight formal mergers of CCG and (as at August 2018) 117 CCGs were sharing a boss - known as the 'accountable officer'.
In October 2018 it was announced that 24 CCGs were deemed to be 'failing' and in need of care and attention. The problem with all this is that our WCCG was far from failing. It was - and still is - in good shape both financially and as regards its innovations and improvements.
It did not always see eye-to-eye with Wiltshire Council - it is not alone in that. And some of the CCG's schemes have not quite lived up to expectations, but many have.
Its workload has expanded since 2013 - it now has delegated responsibility (from NHS England) for commissioning the county's GP services. As these are being reconfigured into Primary Care Networks, the CCG will perhaps have lasting responsibility to look after PCNs and ensure they make the improvements they are going to be paid for.
However, CCGs are a protected species. They are statutory organisations under Lansley's Health and Social Care Act 2012. So all these changes are 'work-arounds' that must continue to feature a CCG presence in the overall system.
The WCCG will undoubtedly become smaller - but, under the Lansley Act, will still have to hold board meetings in public.
One straw in the wind in favour of itssurvival is that NHS England have - starting with 2019/2020 - issued CCGs with funding allocations across the next five years. But that could, of course, change.
Just supposing the Brexit mess is finally sorted, and the government gets back to governing the country, it could well be that a bill is put before Parliament that would take CCGs out of the NHS's complex organogram altogether - or simply subsume them into the STPs.
We will need to ensure that the mega-CCG and the mega-STP are both working well and are still able to work for Wiltshire patients. To do that we have to ensure they become more open and more transparent - so we know what they are doing.
This is the second in a series of articles on the new shape of the local NHS - following our introductory report of 28 March 2019. Next: have you noticed our STP yet?