GPs doubt CCGs will improve the NHS but we must accept the challenge head on given the opportunities for change, engagement and transparency, says Steve Kell
I was eight when I joined my first membership organisation: the Dennis the Menace fan club. The absence of an Xbox, PlayStation or even a smartphone resulted in a childhood with simpler pleasures, and I can still remember the thrill of opening the envelope containing the black and red badge that signalled entry to the club.
Looking back now, it was a waste of 45p. Membership meant nothing but a badge declaring a passion about something.
‘As chair, I am always conscious that I represent members and the governing body, and that I can be replaced if I fail’
So will membership of a clinical commissioning group be any different? For some, I have no doubt, it will not be. There could be a badge declaring “I love the NHS”, there are many designs on Twitter profiles, or “I love my local hospital” − but will there be a genuine sense of belonging to an organisation that has responsibility for providing safe and sustainable healthcare? Will we achieve anything? Engagement is a key challenge for CCGs and clinical leaders.
The choice of a membership model for CCGs is interesting. It significantly changes the dynamic from primary care trusts. There is no chief executive with overall authority and the membership chooses its own clinical leaders.
‘A transparent culture, focused on quality, will make difficult conversations easier for members and communities’
As chair, I am always conscious that I represent members and the governing body, and that I can be replaced if I fail to represent and consult adequately. There are challenges in the model, with the potential to make difficult decisions more so.
But there are also opportunities. Effective communication between GPs, patients and the group, with transparency about local issues and decision processes, has the potential to be a key driver for change.
What does the membership model mean for GPs and for me as a clinical chair? It is essential that the focus is on quality. GPs and patients care about local services. They are passionate about local hospitals.
‘Members should feel free to challenge conflicts of interest, have access to information and ensure robust policies’
We have not always had the information we needed to know, or to advise patients, about the quality of services. A transparent culture, focused on quality, will make difficult conversations easier for members and communities.
A focus on finance and activity levels will not. If decisions have to be made on financial grounds, being open about the situation and the available options is vital.
Membership organisations, built upon local democracy and with strong patient engagement, will be tested by issues such as reconfiguration and specialisation.
In Bassetlaw, as with other CCGs, the governing body meets in public. Members who worked in PCTs have commented on the increased clinical focus in the discussions, of examining data and the increased level of clinical engagement across primary, secondary and community services.
We have started to update members after each governing body meeting, so each person will be aware of performance locally and commissioning priorities. As a small CCG we have advantages with member engagement, but information and data sharing has led to a number of improvements locally, including prescribing quality and urgent care systems.
Being realistic about priorities and timescales, and identifying areas where improvements are most needed, are important if members are to feel the group is an organisation that can deliver.
Cynicism towards CCGs
A recent survey of 600 GPs found relatively little belief that CCGs will improve the NHS. This may be due to CCGs themselves, or to a wider belief about the challenges facing the NHS, but we have a chance to make real changes and we should grab the opportunity.
Each group is likely to have some conflicts of interest, and all members are providers of services as GPs. Members should feel free to challenge these, have access to information and ensure each CCG has robust policies in place.
‘Patients and the NHS need clinical commissioning to be successful. We need to grab this opportunity to improve services’
There are many challenges to clinical commissioning: GPs’ workload, new primary care contracts and constraining running costs are just a few examples. We have spent a lot of time and effort locally ensuring we have the clinical leadership, supported by strong management, to make the best use of clinical and managerial time.
In a time when their workload is at its highest, when practices face income challenges and new commissioners themselves, asking GPs to be directly involved in commissioning can be difficult.
Patients and the NHS need clinical commissioning to be successful. We need to grab this opportunity to improve services, increase engagement with members and the public and develop a sense of responsibility beyond our surgery doors. There are opportunities to improve primary, secondary and community services.
General practice, so used to adapting to change, is up to the challenge. To those who are sceptical: get involved, tell us what you think locally and help shape the future.
Dr Steve Kell is chair of Bassetlaw CCG and co-chair, NHS Clinical Commissioners Leadership Group
Steve Kell will be speaking at the Commissioning show at the Excel in London on 12-13 June. For more information and a full list of speakers visit the event website.