Clinical commissioning is an opportunity for the NHS to refocus on patients and quality, says Steve Kell from Bassetlaw Clinical Commissioning Group

Life as a clinical commissioning group chair, it’s all about the Ps and Qs. This is not just a case of minding one’s manners and being aware of behaviour and collaboration, but a real focus on patients and quality. Clinical commissioning, with more clinical and public engagement, is an opportunity for the NHS to move beyond a focus on activity. 

‘Patients often don’t care who commissions a service or who negotiates the contract’

Of course we have a responsibility to meet pledges and balance the books, but my role is to listen and engage. To make sure everyone counts. The challenges for the NHS are clear for all to see, emphasised by the Francis report. With significant financial pressure and reorganisation it is vital that commissioning is effective. 

The reforms have not, in my opinion, “given all the power to the GPs”. This is a system where responsibility is shared, but where clarity is essential. One of the key messages from the Francis report is the importance of responsibility and accountability. To assume someone else is responsible for quality is not acceptable.

However, there are now more organisations involved in commissioning and provision, so how do we avoid a “collusion of anonymity”? Shared responsibility is a powerful tool if used correctly, but it relies on behaviour, communication, transparency and a relentless focus on patients and quality.

Tangible benefits

We are keen to build upon this sense of collective responsibility at Bassetlaw Clinical Commissioning Group. Patients often don’t care who commissions a service or who negotiates the contract. They do care about the quality of services delivered, about the transparency of outcomes, about the system communicating well to improve their care. 

Dementia is one of the challenges facing general society that cannot be solved by the NHS working alone. With one in three people aged over 65 likely to die with dementia, approximately a third of acute hospital beds and the majority of places in care homes occupied by patients with dementia, we need to work as communities to ensure services are safe, high quality and accessible.

‘We are just part of a complex system. We all, clinicians and managers, need to be strong patient advocates’

Last month in Bassetlaw we were proud to lead a local community dementia summit, with local carers, providers, the local authority and emergency services in attendance. There were clear outcomes from the meeting, agreed with carers, including the signing of a symbolic “dementia pledge” to work together as a community.

One of the tangible benefits of clinical commissioning and collective responsibility has been the increase in discussions between primary and secondary care clinicians, both nursing and medical.

There are many excellent ideas to improve services and outcomes and working together has seen a number of improvements locally across primary and secondary care. Allowing providers to innovate, to discuss pathways inside and outside the hospital, is crucial if we are to achieve meaningful change. 

Sharing responsibility

In Bassetlaw, for example, there has been a significant reduction in the incidence of C. difficile due to changes in primary care antibiotic prescribing, led initially by microbiologists in secondary care.

But there are significant challenges ahead if we are to be effective as clinical commissioners. If we are to share responsibility we have to define what that means, clarify roles and accountability. 

‘I hope we can move towards an NHS where board meetings done privately are the exception and where information is shared freely’

We are just part of a complex system. We all, clinicians and managers in each organisation, need to be strong patient advocates. This may involve challenging other parts of the system. It may be uncomfortable at times.

In the consulting room, we need to be assured of the quality of services we refer to. The NHS Commissioning Board, the local authority and the CCG need to be assured that each is delivering. 

Improving cancer outcomes, for example, relies upon Public Health England, CCGs and the board commissioning collaboratively, ensuring pathways work. Health and wellbeing boards are becoming increasingly important in ensuring the system is effective, as the place where the commissioning board, CCGs and local authorities meet and are challenged. 

A learning organisation

The last year has been a steep learning curve for health and wellbeing boards, and there is still a lot of development needed, but if they can move to a model of genuine governance they could be a key driver of integrated commissioning.

All of this relies upon better information and transparency. We commission on behalf of patients. I hope we can move towards an NHS where board meetings done privately are the exception and where information is shared freely

Only then can patients exercise meaningful choice and challenge local services. Through information, and behaviour, the NHS needs to become a learning organisation, sharing good practice and learning from mistakes. 

As a CCG we are learning but we have been particularly keen to learn from organisations outside the service such as the voluntary sector, and to develop with others with the help of the Commissioning Assembly and NHS Clinical Commissioners.

The Francis report is an opportunity for the NHS to learn and to improve: to focus on its most important Ps and Qs. 

Dr Steve Kell is chair of Bassetlaw Clinical Commissioning Group