Next month the Health and Social Care Bill goes back to the House of Commons after the government’s rethink. MPs will have 160 government amendments to consider. This Bill will have a direct and radical impact on how the Marlborough area’s NHS provision is run.
Marlborough News Online continues its reports on the NHS’ restructuring by interviewing Marlborough area GP Dr Jonathan Rayner about the new organisations and about Savernake Hospital.
Dr Rayner has been a GP at the Ramsbury and Wanborough medical practices for the past twenty years. He’s married with three children, sits on Aldbourne Parish Council and he leads the East Kennet part of the clinical commissioning group (CCG) for north and east Wiltshire that in April 2013 takes over the commissioning of health services for our area from the Wiltshire primary care trust (PCT).
When Marlborough News Online spoke to Dr Rayner about the progress in the coalition government’s root and branch restructuring of the NHS, general practitioners’ frustration with the process of change was clear. That’s not only because the process is moving at what Dr Rayner calls ‘a glacial rate’ and the government keeps altering the rules.
He and his colleagues are still unclear how much autonomy they will have. The coalition’s white paper indicated that power would reside locally. But now, Dr Rayner believes, more will be ‘dictated from above’. In addition: “More and more limitations are being placed upon us – we have to keep very nimble.”
“The bits [of the changes] the patients are most interested in are still to come.” For instance the CCG’s use of Savernake Hospital has not yet been discussed “because we’ve been far more involved in the nuts and bolts of setting up the consortium.”
Dr Rayner acknowledges that “Savernake hospital has been under-utilised”. However, he warns: “Whether we can put in the sort of services people in Marlborough want is another matter – because of the economics.”
He describes as ‘a huge burden’ the PCT’s payments for the private finance initiative (PFI) agreed in 2002 which funded the enlargement, refurbishment and equipping of the hospital. He says the question of who will take over those payments in the re-shaped NHS has been kicked into the long grass and he does not expect any resolution within the next eighteen months.
How far have the plans advanced for the CCG that will cover the Marlborough area? “ It’s difficult“, he said, “to finalise our structure when the government keeps changing its mind.”
But progress has been made. The CCG now has a name: NEW Consortium – where NEW stands for North and East Wiltshire. And under the government’s latest regulations they will probably have to tack on an ‘NHS’ – maintaining the NHS branding is important to the government.
NEW Consortium has a chairman, Dr Simon Burrell from Corsham. It is about to get a manager. And it has an interim board of six GPs. Other members of the board, including patient representatives, will follow.
The NEW Consortium will be one of three CCG’s to replace NHS Wiltshire. The others cover the south of the county and the west of the county. But the plan is for some services, mainly back office ones, to be centralised – covering all three CCGs. This could include human resources, payroll, information, relationships with other health bodies in Wiltshire and governance.
They have not decided where their headquarters should be. To save money they might decide to have a ‘virtual HQ’ with the centralised admin services in Devizes – where the current PCT is based.
If that all sounds very complicated, there’s much more complexity to come – with scores of new quangos to be established across England. The Department of Health has yet to produce a diagram – known to management buffs as an organogram – showing how the new NHS and its many organisations will work.
But policy experts at the Labour Party have had a go. If you want to start understanding how it is supposed to work you can check out their organogram at: on an FT blog which includes before and after diagrams or in The Guardian.
The funds the CCGs will have to buy health services from hospitals and clinics will be very tight. Now there’s a real fear that many PCTs across England are not making the necessary savings from their current budgets to meet the coalition government’s £20 billion cut in NHS spending by 2015. A survey by the General Practitioner journal shows there might be a large shortfall which would mean the CCGs inheriting huge debts.
That scenario takes us back to the present PCT – known as NHS Wiltshire – which when it was formed late in 2006, inherited a debt of £64 million that it is still paying off. This debt was due in part to the overspend by Kennet and North Wiltshire PCT in modernising and then running Savernake Hospital.
History better not repeat itself: that huge historic deficit inherited by NHS Wiltshire arose when Wiltshire was divided into three PCTs. Now the county is going to be divided into three again – this time into three clinical commissioning groups.
