Clinical commissioning group leaders say they have a high level of confidence their organisation would detect and prevent a serious care failure like those at Mid Staffordshire Foundation Trust or Winterbourne View hospital, an HSJ barometer survey reveals.
Asked to rate their confidence between one and 10 – the latter score being entirely confident – the average was 7.3.
Their confidence contrasts with that of other NHS leaders. An HSJ barometer of hospital trust chief executives in July saw 44 per cent say they were not confident the NHS and regulatory system could pick up a Mid Staffordshire type care failure.
CCG leaders’ confidence may also be a surprise as their organisations are at an early level of development and many of them – as well as their commissioning support units – have not yet filled all staff posts.
The system has been in a state of turmoil. An HSJ analysis in May found there had been a tripling in staff turnover among the NHS managers, nurses and doctors responsible for monitoring hospital care quality.
CCGs also have fewer staff than primary care trusts and there have been concerns about whether they will have senior staff overseeing care quality.
The confidence could reflect a belief that CCGs’ GP membership will make them better attuned to safety and quality concerns.
A report produced on a seminar held as part of the Francis public inquiry into Mid Staffordshire identified a “belief that better relationships between primary and secondary clinicians will enhance the system’s ability to identify and solve problems and to make care better”.
Johnny Marshall, a GP, advisor to the NHS Commissioning Board and senior member of NHS Clinical Commissioners, said authorisation tests meant CCGs were aware of their strengths and weaknesses in relation to quality, which gave them confidence. He said they were devoting significant time to the issue and aware of the need to work with others in the system.
Meanwhile, the CCG barometer reveals CCGs’ priorities are focused on reforming the urgent and emergency care system and long-term conditions care. Asked to identify their top three service changes priorities, 91 per cent identified urgent and emergency care and 90 per cent said community long-term conditions services.
The next most commonly chosen was general practice, with 41 per cent. CCGs do not have responsibility for commissioning primary care and do not hold GP practice contracts. However, they do have a duty to support its improvement, and some have argued it will inevitable be a for GP-led organisations.
CCG leaders’ concerns
“Budgetary pressures and QIPP challenge looks enormous beyond 2014-15.”
“There is little chance of implementing any new plans because of difficulties determining budgets and contracts.”
“Major hospital reconfigurations taking up the majority of quality time when we need to be developing safe and secure systems. Not spending enough time engaging with our members due to lack of time.”
“Staff are still not all in post and the way we have treated these people [and the] effect of this on morale is frankly a national disgrace.”
“Transfer of risk onto CCGs is very worrying: eg Continuing Healthcare, extension of specialised care definitions. We appear to being set up to fail.”
“Same old problem of, in reality, only one acute provider, and limited levers to effect change. Depends on how bullish we will be allowed to be.”
“Positives [are] a great bunch of managers and clinicians in our CCG, much closer relationships with local authorities.”
“Changes to primary care and [the quality and outcomes framework] could not have happened at worst time - GPs will walk away from commissioning.”
“NHS Commissioning Board regions and area teams don’t work well yet. Every layer seems to need to know whatever it feels it needs to know ‘urgently’. [They are] struggling to let CCGs be responsible, so trusts can still go around CCGs to address financial issues.”