CCG authorisation conditions should be framed in a way that helps the new organisations focus on the areas they can reasonably influence, says Matthew Harker

Manual focus

Seeing your recent article around the potential need for temporary restrictions to be placed on CCGs, I was reminded of the NHS Commissioning Board’s stated ambition, reiterated by Barbara Hakin in April of this year, to “bend over backwards to have the maximum number of CCGs authorised with the minimum number of conditions”.

It’s worth returning to that aspiration in relation to some of those operational planning issues which CCGs are now facing and some of the discussions around temporary conditions and restrictions that have recently surfaced. 

Some of these restrictions clearly relate to issues which are outside CCGs’ current sphere of control, for example the detail behind parameters to support the 2013-14 planning round. 

It seems helpful, therefore, to be able to distinguish more clearly between conditions for authorisation - relating to specific aspects which a CCG needs to address - and extraneous issues - relating to planning processes or the state of development of external partner organisations.  

That way, CCGs can focus more clearly on the things that they can reasonably do to become fully authorised.

Matthew Harker, director, Capita health consulting

A change with teeth

A report by NHS watchdog NHS Protect this year has estimated that under the current dental contract system fraudulent dental claims for about £73m worth of treatment were made in 2009-10.

Incredibly, according to NHS Protect, it is estimated a further £146m could be lost to dental fraud before a new dental contract can be introduced in April 2014. Health minister Lord Howe and others have said that the current system is too open to abuse. 

Half of the fraudulent claims submitted to the NHS were for more expensive dental work. It occurs to me that rather than wait until a new contract can be introduced, a simple design change could be made to the form that is signed by the dental patient.

Usually patients are asked to sign and date a form at the start of a course of treatment, without knowing what they are really signing for. As NHS treatments are now grouped into one of three broad bands, what should happen is that the patient or dentist has to tick a banding box on the form at the end of the treatment, to confirm what type of dental treatment has been given and only at that stage is the form signed. Most patients have a good idea of what kind of treatment they have received.

This simple change to the dental form could help prevent some further fraud from happening and allow the saved funds to be put to better use.

Dr Marie McDevitt, specialist in public health, NHS Stockport

Olympian challenge

I read your recent article RCP: Hospitals are overcrowded and short-staffed with some interest.

It is just weeks since we saw it honoured on the world stage, but the NHS faces a severe challenge if it does not curb the demand for acute care. Much of the problem centres on the fact that until patients walk into A&E, we have hardly any knowledge about their condition. For example, if people are reluctant to see their GP before their situation becomes serious they may have undiagnosed conditions, or key information about them available elsewhere may not be shared with the NHS.

It has long been recognised that early medical intervention not only significantly improves patient wellbeing and survival rates, but also greatly reduces the burden on the NHS and therefore the taxpayer.

However, in order to be able to target and support these high-risk patients, the NHS first needs access to reliable, up-to-date information on patients and citizens, including relevant data from external sources like local authorities. Only then will it be able to make better and predictive fact-based decisions, such as when to discharge a patient, send out a community nurse or request people see their GP.

This is about seizing the opportunity to ensure the longevity of a much celebrated British institution, and for the NHS to deliver better value for money and improved patient care.

David Downing, healthcare specialist at SAS UK and Ireland