• Outgoing Cambridgeshire and Peterborough CCG chief calls for focus on demand and primary care
  • Tracy Dowling says progress has been made but CCG faces “significant financial challenge”
  • Acute configuration will not be about “closing capacity”, she says

Cambridgeshire and Peterborough Clinical Commissioning Group, one of England’s largest commissioners, must not get “distracted” by designing new structures following its improved rating, its outgoing chief officer has warned.

Tracy Dowling, who becomes chief executive of Cambridgeshire and Peterborough Foundation Trust next month, told HSJ the CCG’s priorities over the next two years should be controlling demand and shoring up its primary care provision.

Tracy Dowling

Tracy Dowling said the capped expenditure process had been ‘really helpful’

Ms Dowling said: “We face a significant financial challenge and it won’t be easy for any organisation within the STP… We do not want to get too distracted by coming up with a structure for an accountable care system.

“The main aims for the next two years are getting hospital demand under control and developing sustainable general practice. The ACS structure will be something that we evolve towards over a number of years rather than arrive at by a dramatic revolution in the next few months.”

The health economy has one of the largest deficits as a proportion of overall turnover of any area, with a forecast deficit of up to £250m by 2020-21. The CCG was one of 18 upgraded by NHS England last week from inadequate. It is now rated requires improvement.

The Cambridgeshire and Peterborough sustainability and transformation partnership, which is conterminous with the CCG, was rated “advanced” and ranked in the second best category by NHS England. Ms Dowling is accountable officer for the STP.

The ratings are a boost for the health economy’s leadership, which has faced significant criticism in recent years following the collapse of the £750m UnitingCare Partnership contract and concerns about its governance and leadership.

Ms Dowling said “really good progress” had been made on restructuring the CCG so it could “get back to balance… maybe in the next year, or the year after that”.

She admitted “difficult decisions” still needed to be taken around service provision. While significant transformation of urgent and emergency care provision is required, she said the STP was not about “closing capacity”.

She said while the plan was “not yet the finished article” it showed a “clear and concise” direction of travel. “We need to be much clearer on the granular delivery of some of the long term changes; the workforce challenges; how we will use technology to better effect,” she added.

The CCG’s role over the coming years would be focused on “understanding the population’s health needs and what improved outcomes for our population look like”, she said. “We have restructured the CCG to align our staffing with the transformation challenges that the STP presents.”

The CCG missed its initial planned deficit of £3m for 2016-17, and instead hit a revised £17.4m deficit control total. It then released 1 per cent of its reserves, meaning it recorded a formal deficit of £7.5m. The CCG  has forecast a £31.5m deficit for 2017-18, including its historic debt. It agreed a £15.5m deficit control total with NHS England for this financial year. 

The CCG has been included in the capped expenditure process, which consists of 14 health economies chosen largely because system leaders expected them to fall short of their 2017-18 control totals.

These areas were told to “think the unthinkable” and take “difficult decisions”, such as closing wards and services, extending waiting times, and stopping some treatments.

Ms Dowling said the CEP had been “really helpful”. She said: “It’s made sure there is absolute clarity about the differences in assumptions and risk between the provider and commissioner plans. It has helped to focus at a much earlier stage in the year than might previously have happened in terms of developing actions to mitigate risks arising from differences between commissioner and provider plans.”