Primary care trust leaders are overwhelmingly confident about the progress being made towards setting up the new NHS structure, internal reports obtained by HSJ reveal. However, many areas are experiencing difficulties establishing the local operations of the NHS Commissioning Board.
The Department of Health’s NHS transition tracker shows that most clusters are advancing well towards setting up clinical commissioning groups and commissioning support units.
There are strong ratings on establishing any qualified provider contracts, setting up health and wellbeing boards and moving public health functions to councils and Public Health England.
The tracker is made up of submissions from all 50 PCT clusters, and rates progress on seven key “domains” relating to the structural reforms. Clusters are given a red, amber or green rating for each domain.
The only issue causing widespread concern is setting up the “direct commissioning” functions of the commissioning board’s local area teams, such as primary care, specialised commissioning and prison health. This was rated amber by a third of clusters, including all in the North West and four out of five in London.
Many clusters complained about a lack of guidance from the commissioning board on how direct commissioning would work in future.
The board’s failure to produce full shared operating processes and compliance frameworks for direct commissioning were widely cited as the main reason for amber ratings in this area. South Essex cluster expected to be able to adopt a common contract compliance framework by March next year - nine months behind plan.
One senior commissioning source told HSJ that the board was currently having to unpick the functions it would be taking on in future from 150 PCTs, assess how they operated locally, identify the best systems and design a model that could be applied universally.
In the North West, the tracker revealed that Bolton Clinical Commissioning Group had been moved from wave two of the authorisation process to wave four, pushing its authorisation back by two months. This was due to “local acute trust issues that need their immediate attention”.
A lack of London-wide guidance on public health was cited as affecting the transition of public health services, with emergency planning roles still unclear. Meanwhile the South East London cluster said it was still unclear which screening and immunisation responsibilities would be undertaken by the board.
HSJ analysis of the tracker shows that seven clusters have three or more amber ratings out of seven, while 18 had green ratings across the board.
Luton and Bedfordshire was the only cluster with any red ratings, having highlighted concerns over the implementation of any qualified provider. The problem was the lack of national specifications for wheelchair services - an issue also highlighted by other clusters, including Norfolk and Waveney and South East London. Luton and Bedfordshire expected to implement any qualified provider on wheelchair services by December - three months after the original deadline.
Senior PCT cluster leaders told HSJ that overall managers were confident the new system would be able to take over the running of the NHS by the end of March. One referred to a “blitz spirit” among NHS leaders in setting up the new organisation, and a new spirit of collaboration, rather than self interest, across teams and areas.
A commissioning board local area team leader said the apparent success in setting up the new structures did not necessarily mean the new system would be better at solving the long-term financial and performance problems faced by the service.
Another senior commissioner told HSJ: “I think it is going remarkably well, given this is the most badly organised reorganisation I have experienced in 30 years. Politicians have cocked it up but NHS managers are working their socks off to make the damn thing work.”
However, one commissioning board source pointed out that the tracker only assessed the establishment of new structures. There remained “high levels of anxiety” over whether either CCGs or local area teams would have sufficient resources to undertake their duties, and whether all PCT functions would find a home in the new system.
“This is a short-term perspective,” he said. “Things look green, but there is no complacency. This does not mask other challenges - we’ve got some really precarious provider organisations - at some point that will be an issue for commissioning organisations.”
Clusters with seven green ratings
- Cambridgeshire and Peterborough
- Norfolk and Waveney
- Calderdale, Kirklees and Wakefield
- North Yorkshire and York
- Birmingham and Solihull
- West Mercia
- Wiltshire and Bath and North East Somerset
- North of Tyne
- County Durham and Darlington
- South of Tyne and Wear
East of England SHA on Luton and Bedfordshire “This PCT cluster is affected by the national AQP delay for wheelchair services, and will not deliver the national AQP milestone until December.”
London SHA on North Central London “Slippage against CCG development milestones has been caused by a delay in the delegation of budgets to Enfield CCG.”
West Midlands SHA on direct commissioning “The Black Country cluster is generally demonstrating good progress, with the exception of ‘direct commissioning’ where there are risks to staff retention.”
South East London “We are awaiting national guidance and clarity as to how key responsibilities for immunisation and screening will be undertaken by the NHS Commissioning Board.”
South West London on screening and immunisation “Awaiting London-wide guidance in order to develop joint plans.”