Kingston was one of the first clinical commissioning groups in England to be fully authorised. Chief officer David Smith reflects on the process and explains why it’s only the start of the hard work for the new bodies
The long awaited authorisation announcement for the 34 first wave clinical commissioning groups was made last month. As the NHS Commissioning Board has made clear, the authorisation process is not a competition. But it is fantastic for us at Kingston CCG that it is one of the first eight CCGs to have been fully authorised.
However, we are all too aware that this is the start of a journey and not the end.
‘We need to remember this is the first time the process has been run so a few problems are inevitable’
Before the real work starts, I would like to offer some personal reflections on the authorisation process. The later waves of CCGs are of course still going through the process, so some of the following lessons from Kingston might be helpful.
Many of us at Kingston who had been through the world class commissioning process initially thought CCG authorisation was “world class commissioning revisited” − or as one of our GPs put it, “world class commissioning with bells and whistles”.
Having reached the end of the CCG authorisation journey, while there were some similarities, this has been far more challenging and rigorous than the earlier process. It has also been fairer. Being able to provide the required evidence before, during and after the site visit has enabled CCGs to have the best possible chance of demonstrating how they meet the criteria.
Rigour and red lights
Of course, I don’t expect everyone will see it that way, particularly the CCGs that still have a lot of red lights following their site visit by the commissioning board. As someone who has also been on the other side of the table as an assessor − which incidentally I did after Kingston’s site visit − it is apparent to me that a number of the criteria could have been better defined.
For example, who can best judge whether “configuration is appropriate” for a particular CCG? And on what basis can “senior in-house capability and capacity” be properly assessed?
‘Authorisation cannot be seen as the end point and now is the time to redouble our efforts to improve services’
We need to remember this is the first time the process has been run so a few problems are inevitable. My experience as an assessor has found the desktop assessment is a rigorous process. To a certain extent if the evidence has not been provided, then CCGs can hardly complain if they get a red light.
The downside of the process has been the time involved to do the assessments and this has led to some difficulties attracting assessors and panel members.
Just getting started
Achieving authorisation cannot be seen as the end point and now is the time to redouble our efforts to improve local health services.
The authorisation process will continue to have significance for the day to day work of every CCG. For example, the criteria and the domains can be used as part of the framework to determine how the CCG does its business. Clearly a number of the criteria are in the “yes/no” category, such as “do you have a secondary care doctor on the board?” or “have you published your complaints policy?”.
In my view the more interesting ones relate to how CCGs engage with patients and the public, how CCGs are involving member practices, and how CCGs deliver improved service quality. What is clear is that CCGs need to constantly check they are still meeting the criteria and be self-critical.
‘From April it will be more important than ever that we are accountable, transparent and involving patients’
At Kingston we are clear on our immediate priorities. We are under no illusion the future will have its challenges, particularly with the increased demand on the NHS budget. The joint leadership we have in place across health and social care means we are in a good position to make sure we organise services as efficiently and effectively as possible for local people.
A programme of improvements to mental health services will include the launch in early 2013 of a new community wellbeing service. This will provide a joint service with the council to treat substance misuse and provide psychological therapies − making it easier for patients to access services and recognising these areas often need to be treated together.
From April it will be more important than ever that we are accountable, transparent and involving patients in the decisions we make.
Patient engagement is therefore another of our priorities − our aim is to embed engagement in the CCG processes; for example by ensuring that all board reports have undergone the appropriate level of engagement before they will be considered and establishing our regular patient forum. We need to do more but we are moving in the right direction.
The transition from a “shadow” to “statutory” organisation will be significant for all CCGs, as we learn the full nature of our responsibilities and how to stand on our own two feet.
Making sure we have done all we can to meet the rigorous authorisation criteria will create a stronger platform for CCGs to begin operating from. Of course, then we just have to get on and do it.
David Smith is chief officer at Kingston CCG and director of health and adult services at Kingston council