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Third of CCGs reluctant to become statutory bodies, PM warned

The prime minister and health secretary have been warned that a third of clinical commissioning groups would rather not become statutory bodies because of the burden of bureaucracy involved.

Dr Michael Dixon, chair of the NHS Alliance, said that many frustrated CCGs would rather leave statutory obligations to other bodies and carry on commissioning as a “subcommittee”.

Under the Health and Social Care Bill, CCGs will be legally responsible for commissioning from April 2013, although ministers have said the NHS Commissioning Board will take over where CCGs were not ready, willing and able.

Speaking in Manchester at the HSJ Commissioning Forum North on 28 September, Dr Dixon said CCGs were increasingly frustrated at being told how big they should be, and the burden of complying with central requirements on corporate governance.

He said: “There is something really worrying at this moment, which I’ve had to warn Number 10 and the secretary of state about.

“Some CCGs are moving away from wanting to become statutory organisations, saying: ‘If we’re going to have to be enormous, and do all this stuff, and you’re going to set up lots of guidance, why on earth should we put our necks on the block? Why not leave all that stuff to someone else – the son or daughter of a primary care trust cluster, and we’ll carry on as a CCG advisory group, subcommittee of that future organisation?’

He added: “Almost a third countrywide are thinking of doing just that.”

Dr Dixon later told HSJ that if CCGs decided not to comply with the authorisation process, then a situation in which PCT clusters or the NHS Commissioning Board remain in charge could “drag on endlessly”.

But, he added, it would be better if all CCGs were statutory bodies, and that the obligations placed on them “don’t make everyone break out in a rash because of the enormous amount of red tape involved”. “The challenge to the commissioning board will be to loosen up,” he said.

Paul Wike, lead manager of Sheffield CCG, told the forum the biggest problem clinical commissioners faced was “all the other stuff put on our doorstep”.

He told the forum: “We can commission really well – it’s the bureaucratic stuff, the returns to the Department of Health, that will stop us doing what we do best.”

David Jenner, a GP involved in commissioning in Devon, said he has been angered by central guidance on 111 service procurement and Department of Health directions on extended choice of provider. He also said he was “passionate about commissioning” but anxious about CCGs taking on the risk of potential lawsuits.

“CCGs could have devolved responsibility for budgets but not the final accountability – we could still add real value without getting enmeshed in all the bureaucracy.”

But Steve Kell, executive chair of the Bassetlaw Commissioning Organisation, stressed the importance of public and corporate accountability, and emphasised the role of managers in the work of CCGs. He told HSJ: “Governance, audit, and patient involvement go with managing a budget… it’s not just GPs doing this on their own.”

Readers' comments (9)

  • 'we can commission really well...' so let us do what we want without being accountable. Let us tinker at the edges and others make the big decisons. Good grief there really is no hope.

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  • “We can commission really well – it’s the bureaucratic stuff, the returns to the Department of Health, that will stop us doing what we do best.”

    This could have been said by a PCT manager. The GP's are right about this but unfortunately bureaucracy is only something the Govt want the public sector bodies to stop doing, probably because they think it is somehow invented by PCT's. They didn't mean the mountain of meaningless beast feeding that they require on a tediously regular basis. The Govt will not have such an easy ride with GP's over their unreasonable demands - they will, quite rightly ask WHY?

    However did they really think the DoH would entrust them with 80% of the NHS budget to play with (sorry commission with) without micro-managing their every request for a post-it note?

    For intelligent, bright people they perhaps need to get out more - no such thing as a free lunch in the fraught world of healthcare i'm afraid Dr. Be intereting to see the winner in this one.....my money would be on Messrs Nicholson, Lansley, etc. But a good fight to watch from the ringside!!!!

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  • It's going to be really interesting when CCGs who take early delegated powers then come to consider full authorisation. Why would you?

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  • This would be funny if it weren't so predictable...who remembers AL promising GPs 'light touch regulation' when he was busy enticing them with promises of a new world where they would be in charge to commission what they want?...how many of us remember thinking how naive GPs were if they believed that the Treasury would happily give them £80billion to spend with no strings attached and no statutory accountability?...oh how they will rue the day when they criticised PCTs for obstructive bureaucracy'..and believed that AL could actually 'liberate the NHS' ..this is a classic case of be careful what you wish for or you may get it ...well they have and they don't like it...what a mess this has all become and there seems no end in sight.

    And AL had the audacity to say the other day that if Labour ever ran the NHS again they would run it into the ground...what a joke when he has run it into the ground and is busy burying it.

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  • Good on DickyBow for speaking out on this. If we are to have innovative and local GP commissioning lets have it with all the upside and downside risks involved. AL having launched this now needs to reign in his DH officials and standback and see which way the coin falls.... its boom or bust

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  • Just like PCGs. They would have worked if they had not been forced into PCTs by the desire for power, independence; the corporate concrete boots came into play....

    The 12 lost years need to be reclaimed.

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  • Let's just remember that one person's bureacracy is another person's accountability. If you're spending that much public cash then you need to have structures. It's not 'corporate concrete boots' but the requirement that you spend public money responsibly and accountably.

    Culturally, 'independent contractor' status is really attractive for people who don't want to have to work with in a system and controls.

    One side of clinical autonomy is that you can demand to do what you like for the patient in front of you without any concern for the sustainability of the system (the NHS) at all. And if you say 'No' to someone, rather than being big enough to take the responsibility yourself you can blame 'the system'.

    I'm not saying that everyone is like this - but there are enough people like it to make this more than just a crude stereotype.

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  • I would like to welcome CCGs to the public sector! For goodness sake - did they really expect to get authority without responsibility? Time to grow up guys.

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  • “We can commission really well ..."

    ... and just how can that be evidenced without at least some of the information reporting, governance, accountability etc? I'm not saying PCTs got it right, in fact I dont think they did, but come on.. GPs have been able to be critical for so long- here is their chance to prove they can do it... and suddenly they dont want to. Welcome to the real world.

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