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CCGs in the limelight as NHS reform row gets brutal

The events set in train by last Friday’s HSJ exclusive about the prime minister’s NHS summit proved highly revealing about the tactics the government is adopting to drive through its reforms.

When broke the news of the summit and its “selective” guest list, the government had two options. The first was to say, “Sorry, the invitation must have got lost in the post” and make it clear David Cameron was prepared to sit down with all, regardless of their opinions.

Instead the government actually hardened its line on the invitations, saying the views of the royal colleges of GPs and nursing and the British Medical Association were well known and the PM only wanted to talk to those prepared to “constructively engage” with the reforms.

It is a tactic which, for the moment, appears to have worked. The opponents complained and strode to the moral high ground. But they stopped short of taking their opposition to the next level. Perhaps their bluff has been called; more likely they plan to shift their energies into fighting government pension proposals even more fiercely.

As the summit took place health secretary Andrew Lansley was writing to clinical commissioning groups, promising them a relatively free hand on competition and commissioning support. The PM included “freedom for local decision making” as one of the “four Fs” underpinning the coalition’s approach to reform.

The CCG pioneers are one of the few cards the government holds in the reform battle – and it wants them to feel loved and reassured that they are not serving as a Trojan horse for increased competition. It championed their efforts in a press release on the day of the summit, despite knowing that many similar achievements predated the existence of CCGs. CCGs leaders will have been a little embarrassed. The last thing they need is the government overclaiming on their behalf for political reasons so early in their development.

Readers' comments (5)

  • Forget Trojan horse for increased competition, long before the impact of that becomes apparent they're an unimissable Trojan Horse for cost cutting on an industrial scale - in London "Out of Hospital" strategies are being developed on behalf of CCGs by the few remaining PCT staff (plus McKinsey..) which require savings of tens of millions per CCG over the next 3 years - the CCGs will be required to own these and explain to the public how they'll be achieved once major public consultation begins regarding proposed hospital reconfiguration (i.e closures) in a couple of months The strategies are complete works of fiction assuming gargantuan reductions in hospital referrals and non-elective admissions which have absolutely no chance of being achieved. The easy pots of cash have been raided in 10/11 and 11/12, now real savings are needed and no-one has a clue how it can be done. It's like watching a car crash in slow motion - there is frenzied spreadsheet completion on a daily basis comapring this benchmark with that benchmark and creating masterpieces of fiction which magically add up to the savings target. My local CCG looks on bewildered and somehow believes that beacuse they'll soon be in charge, when it comes to the crunch they'll do what they want and these numbers won't apply to them. It's like an NHS "The Thick of It" multiplied by 10 - utterly mindboggling.

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  • Anon 2.50, this is a fantastic summary of CCGs in my region too. Plans are written by Hansel and Gretel - fairy tales. Then when they go off track it's death by spreadsheet. I'm reminded of a former PCG CEO who said in our first meeting "we've got all this money, would you like to come and play" to the local GPs and trusts. It was all committed (even in those glory days of 6% growth) and/ or overspent on whizzy schemes. GPs thought they could tinker at the edges with PBC schemes that didn't really link up but then again, they didn't want to be involved in some tough choices. I think once they see the books for 13/14, they'll run and contract it out to someone. Hopefully our local CSU with all the experience, not McFirm....

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  • the thing is that no-one has a clue how to achieve this scale of financial efficiency or even close to it, and that included PCTs even when they had a few staff, and now includes fledgeling CSUs, the King's Fund, the Nuffield Trust, Kasier Permanente, Mckinsey, even the great Roy Lilley, old Uncle Tom Cobley and all - basically whoever you care to mention - let alone CCGs knowing how to do it...the thing is that very soon the music is about to stop and our lovable, cuddly GP colleagues, so busy currently flexing their muscles, are about to be caught slap bang in the spotlight, with responsibility for coming up with the answer - and still they can't see it coming, surely the most blatant hospital pass any government could ever conjure up - let the sport commence..

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  • As the previous post said, I think this will mean we will have to pay for our healthcare at some point. No idea how, but probably like the feature creep in dentistry and optometry. And GPs are shown to be popular/ trusted by various polls, so they will conveniently take the blame. Probably linked to electoral timescales......

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  • A bad episode of Yes Minister?

    I still think we should be fighting the Bill - hardly anyone understands it now. Just think what will happen when we are trying to implement it. Nigel Crisp is correct, its a total mess. We are going to spend months if not years trying to work out the detail. When all the time we could be focused on improving patient care.....

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