However humiliating the Cabinet reshuffle was for Andrew Lansley, the coalition government’s major re-configuration of the NHS is moving forward in Wiltshire. October 1 will be an important day for the GP’s of Wiltshire’s Clinical Commissioning Group (CCG): in all but name, they will be taking over commissioning responsibilities from the Primary Care Trust (PCT) which will be abolished at the end of March 2013.
As Deborah Fielding, the CCG’s Accountable Officer or chief executive, told Marlborough News Online, the GPs are ready for the challenge. But as yet it’s not all cut and dried.
When they get “operational responsibility” for commissioning Wiltshire health care, they will still have the guidance of the PCT – like those dual-control cars the driving schools used to have with the second ‘driver’ only using his controls in emergencies. And although the PCT will retain “statutory responsibility” until the end of March 2013, the new and mammoth quango, the NHS Commissioning Board (NHSCB) will be taking over from some PCT’s officers.
This, in turn, is so that senior people in the PCTs can themselves be freed to join the NHSCB and its local offices. Complicated? Riding roughshod over people’s careers? Perhaps that’s partly why the Prime Minister has moved Mr Lansley from the Department of Health. His timetable for the changes has come a bit unstuck.
Deborah Fielding: “Some things are out of sync producing some difficulties for us. But I feel comfortable with the progress in Wiltshire. We are being well supported by the PCT.” She has worked at senior levels in the NHS, knows a great deal about neighbourhood health services and is especially experienced at integrating teams and organisations.
The timing is tight. The CCG will not be “authorised” until January and has to submit its application on November 1. This will include its three-year plan which is at present in draft form. The plan will take into account the broader perspectives from the shadow Health and Wellbeing Board run by Wiltshire Council, and the views of a wide range of “stakeholders” – including those involved at every health care level in the NHS and the voluntary sectors.
The GPs’ main aim is to ‘Bring care closer to home in Wiltshire’. They want to see more specialist services in the neighbourhood teams and to strengthen community services and help people manage and improve their own health. They have already launched some pilots to put these ambitions into effect.
The GPs’ ambition is to keep people out of hospital. As Deborah puts it, “If there are hospital beds free, you can guarantee they’ll be filled.” Will this hurt the finances of Great Western Hospital? It need not as they run the county’s community health services which will be prioritised and get new investment under the CCG’s policies.
Above all they want to be fleet of foot in making changes to commissioning and to the pathways through treatments that patients are sent on. Going through all the consultations and governance rules, it can take a year to change commissioning priorities: “They want”, says Deborah Fielding, “to be able to change services quite quickly and make them better for their patients.”
And how are the GPs organising themselves? At the CCG Board level it “is very much a similar governance arrangement as the PCT – but with members taking shared responsibility.” They will have the same committee structure as the PCT: Finance, Quality and Clinical Governance, Remuneration and Audit and Assurance. The clinicians on the CCG board will have a nine-to-four majority over the non-clinicians.
The CCG will be based in the PCT’s headquarters – Southgate House in Devizes – but their team of about seventy people won’t fill it. For some of its back-office services the CCG will use one of the Clinical Support Services that are being formed around England. But that’s still being negotiated. The CCG will receive from the government about £11,380,000 for its administration and salaries.
Some CCGs are saying they won’t manage on the notional £25 per head of their populations they get for administration costs. Deborah Fielding judges that “We won’t have much to spare.” This means that they will be more costly to run than the PCT and will not have such a wide area of commissioning – their total budget will be about £150million less than the PCT’s.
Below board level the CCG looks very unlike the PCT indeed. When the government first published its ideas for changing the NHS, GPs in Wiltshire wanted to have three CCGs for the county. They were told this would not be sustainable and so had to merge into one CCG. But they are determined to continue with much more local arrangements.
Wiltshire CCG has the seventeenth largest population of all the 212 CCGs in England. The GPs have decided to divide the CCG into three “localities” each with its own board, GP chairman and its own director. Some “localities” will split even further into “more local groups”.
Our area will be covered by NEW (for North and East Wiltshire) chaired by Corsham GP, Dr Simon Burrell. This is putting a new layer into the system and it’s not yet fully finalised.
It remains to be seen whether the governance for these localities and their relationship with the main board will be robust enough to gain the necessary “authorisation” by April 2013. Deborah Fielding says that these localities will be subject to Freedom of Information requests, but it is not clear whether they will hold open, public meetings.
Deborah Fielding still has no news on the future ownership of Savernake Hospital – now owned and its PFI charges paid for by the PCT. And the minor injuries unit? “I don’t see a minor injuries unit back there any time soon.” But with more emphasis on local and community care, there will undoubtedly be opportunities to keep Savernake Hospital very busy.
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