Local clinical commissioners offer an opportunity to ensure services are judged on patient outcomes, not just increasing competition. It isn’t an optional extra if we are to ensure the NHS works locally, argues Steve Kell

In the last week I’ve seen approximately 100 patients, from baby checks to reviews of severely ill elderly patients. 

I’ve also had a practice meeting with my 13 partners to review clinical updates and discussed local clinical commissioning group services such as gaps in mental health pathways and performance indicators affecting local patients.

Steve Kell

‘The level of “clinical pressure” to improve should not be underestimated’

This is the essence of clinical commissioning. 

The time spent with patients is an invaluable insight into local health issues, and CCG members often raise areas where we need additional or improved services for their patients. 

This level of “clinical pressure” to improve should not be underestimated, and working with managers, patients and other clinicians to deliver change is the reason we are involved in commissioning.

A clear view of competition

CCGs are delivering significant improvements for their populations often by working in partnership with local authorities and providers, some examples of which are highlighted in NHS Clinical Commissioners’ Taking the Lead report.

The scale of the challenge varies for different CCGs, but all are determined to improve quality, local performance and respond to the clinical pressure from members and local patients.

This week has also seen CCGs accused of having a privatisation agenda. This is not true. 

CCGs favour integration over competition as shown in an HSJ survey. Our view is clear: competition should be one of the tools available to CCGs when needed, but used only when it is the best interest of patients. The focus is patients, not privatisation.

Competition is not new to the NHS and was an issue for primary care trusts before CCGs. 

‘CCGs are interested in improving local services, not in creating markets’

European law determines which services need to be put out to tender and initiatives such as “any willing provider” increased provision in some areas without addressing local need and the integration needed for the modern NHS. 

Clinical commissioning offers an opportunity to ensure specifications and tenders are judged on patient outcomes and integration, not just on improving capacity and increasing competition. 

There is undoubtedly more clarity needed in the rules around competition, but CCGs are interested in improving local services, not in creating markets. 

Clinical leadership in the NHS is not an optional extra. It is essential if the NHS is to be sustainable, safe and free at the point of access. The last year has seen a significant increase in clinical discussions, in transparency for patients from local doctors and nurses, and a genuine shift towards recreating community teams to improve out of hospital care.

Patients, not politics

But the demand for services is unrelenting and with everyone working at full capacity designing these services is difficult. 

Recruitment is increasingly a concern and to ease the pressure on the NHS it is essential that we look to other options that often provide better solutions for local patients. 

We have worked with the voluntary sector to improve knowledge of available services among clinicians and patients, with a problem based website identifying local options for patients.

‘We need to trust local clinicians and the power of clinical commissioning’

We are also working with care homes to improve quality and reduce community acquired infections. We work with all local stakeholders to improve services for patients.

We need to trust local clinicians and the power of clinical commissioning. As a local GP with up to 22 years still to work in my practice I feel an enormous level of accountability to my patients and my colleagues to provide safe, sustainable local services and ensure they have access to a wide range of services to support them when needed. 

We should build on this foundation and not be distracted by debates about political agendas and organisational structures. 

This has to be about patients and our populations. Let’s change the conversation, and start talking about that. 

Dr Steve Kell is co-chair of NHS Clinical Commissioners and chair of Bassetlaw CCG

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