Act now to give CCGs a good death

The importance of helping patients prepare for their last few weeks of life has enjoyed overdue attention in recent years.

NHS organisations too have a limited lifespan, and their demise tends to be traumatic for those involved and wasteful of  time and money. The disruption created by the abolition of strategic health authorities and primary care trusts still resonates through the service.

They rarely have the privilege of being able to prepare for their own end and to determine its time and circumstances – but clinical commissioning groups do, and it is an opportunity they should not squander.

Let us be clear – HSJ is not calling for the scrapping of CCGs tomorrow. In fact, such a diktat would simply create the same problems experienced during the Lansley reforms.

Working with the grain

Instead CCGs should recognise that changes taking place across the NHS – most importantly new models of care and the organisational landscape that supports them – will require a shift in the way services are planned and funded. In turn this spells a certain end for CCGs as envisaged in the 2012 Health Act.

HSJ makes this recommendation safe in the knowledge that many CCG leaders recognise this and are already acting appropriately. In doing so they are working with the grain of the GP profession – which is more interested in how services are provided than the commissioning process and would rather, offered the choice, be a member of an integrated provider than a CCG.

NHS England, too, has quietly shifted the emphasis from stabilising the current commissioning arrangements, to helping the service prepare itself for the future. The probable approval of the merger between Aylesbury Vale and Chiltern CCGs is significant, as is the fact that the former is led by the co-chair of the CCG national representative body.

Other straws in the wind include five north London CCGs appointing a single accountable officer across their STP patch and, of course, the imminent merger of Manchester’s CCGs.

The pressure from some quarters to accelerate the consolidation is now intense, with the need for short term cost-cuts, and to speed up decisions about service change, reaching the point of desperation.

Straining credibility

But the transformation of CCGs will take place at different speeds across the country and the models adopted will vary. This is appropriate and welcome – there should be no rush.

Acknowledgement of this situation can be tricky, though. The fear of being seen to run roughshod over legislation means the centre has yet to be as clear as it should about what happens next

The centre needs simply to acknowledge this is happening, provide guidance where needed and make sure no one takes their eye off the care quality and finance balls as the process takes place.

Acknowledgement of this situation can be tricky, though. The fear of being seen to run roughshod over legislation means the centre has yet to be as clear as it should about what happens next. This position strains credibility and NHS England chief executive Simon Stevens needs to more overtly signal the shape of what is permissible – even when it appears to run up against the law.

Nudges and winks have encouraged pioneering areas, while firm shoves from the top have forced change in troubled patches. But this will not work with the more timid, and CCGs where performance is okay.

The centre should also, however, resist the temptation to declare how quickly CCGs should disappear – much as that would please many and provide a good headline for HSJ.

At a local level if CCGs, with help from others, can get this transition right it will benefit staff and the service by providing time to plan for the future. It will also reduce stress, save money (by cutting redundancy bills – and the interim management costs which often follow!) and avoid the perception that the NHS is yet again “rearranging the deckchairs on the Titanic”.

Getting it right, however, will not be easy. In some parts of the country a consensus on what should happen next is quickly coalescing.

The nature of the transition means CCGs will have to continue to try and hold the ring even as they plan their own exit

Elsewhere the conversation is only just starting. The difficulty in some health economies is the lack of agreement about what the future should look like. Often there are alternative views – none of them obviously superior – as is illustrated in the south west, where a new STP-wide lead commissioner does not match the boundaries of government devolution.

Transformation also often conflicts with the short term needs and aspirations of existing, statutory organisations. It has taken many months to persuade Newcastle Gateshead CCG it wanted to share its outstanding boss with a struggling neighbour, for example.

The nature of the transition means CCGs will have to continue to try and hold the ring even as they plan their own exit – and all involved must also be careful not to throw the baby out with the bathwater.

Final journey

CCGs have done good work in many areas and, where advances have been made, they need to be preserved. Again, being clear-eyed about the future will give enough time to make sure what is valuable is retained rather than, as was the case with PCTs, forgotten then painfully relearned.

It would be easy to be cynical about the end of CCGs; to sigh wearily about the potential return of primary care trusts or health authorities; or to bemoan why the reforms of the first part of this decade have made life more difficult than it should have been.

What will be harder but more valuable is to recognise that CCGs are embarking on their final journey and to help make sure it is a good one.