Wirral CCG probe could be 'symptom' of wider problems

James Kingsland, president of  the National Association of Primary Care, told HSJ the issues that led to NHS England’s investigation into Wirral CCG’s leadership were unlikely to be isolated.

The group confirmed last week that its chair, Phil Jennings, and accountable officer, Abhi Mantgani, had “stepped away” from their duties to allow the review to take place.

Jon Develing, NHS England’s regional operations director in the North, has temporarily replaced Dr Mantgani – the first time an employee of the arm’s length body has effectively assumed responsibility for running a CCG.

The action was taken in response to a letter sent to Jeremy Hunt by Frank Field, the MP for Birkenhead, calling for an inquiry into the relationship between “senior members” of the CCG and Wirral University Teaching Hospital Foundation Trust.

Dr Kingsland was formerly the clinical lead for clinical commissioning at the Department of Health and has been a GP on the Wirral for 25 years.

He claimed the NHS had “got clinical commissioning wrong” by putting GPs in charge of too much of the day to day running of local health systems, and that events at the North West CCG could be symptomatic of this problem.

“My understanding was and [Andrew] Lansley’s design was never to have GPs in managerial roles running a local health economy. I would not have supported that,” Dr Kingsland said.

“My experience of putting GPs in managerial roles [is] sometimes we end up with people who are designed to be providers not managers, doing things that then lead to fall out.

“I don’t know whether Wirral is just the first of a number of these episodes; I would be very surprised if it’s isolated,” he added.

Dr Kingsland said it could be tricky for GPs in CCGs to balance the duty to closely collaborate with local clinicians when designing care pathways with the duty to keep their distance when handing out public money.

“Sometimes the two can get mixed up, especially when you have clinicians in managerial positions,” he said.

He also said an outside decision to merge three GP consortia to create Wirral CCG could have exacerbated problems at the body.

“An external decision was taken to create just one CCG which had the same geography as Wirral Primary Care Trust… we glued the three together, which hasn’t necessarily worked, but then again [the original consortia] were designed for a very different reason”.

Dr Kingsland said he was concerned the ructions at the CCG could distract Wirral from more pressing matters. “How are we going to do transformational change when we’re almost in ‘special measures’?” he said

“The senior management team are being… possibly restructured at a time that’s critical to transforming health care,” he added.