• Plans for new primary care organisation halted after “fierce” criticism of those leading the project
  • Independent review highlights various concerns over Trafford CCG’s efforts to create a single primary care provider
  • Project was led by Nigel Guest, the CCG’s former chief clinical officer

The establishment of a new primary care organisation in Greater Manchester has been halted after an independent review heard “fierce” criticism of those leading the project.

The review highlighted various concerns over Trafford Clinical Commissioning Group’s efforts to create a single primary care organisation in the borough, including that a significant number of GPs felt misled over the process.

The PCO was intended to be a functioning provider of primary care services, registered with the Care Quality Commission and holding contracts with the CCG.

The project was led by Dr Nigel Guest, the CCG’s former chief clinical officer and a GP in the borough. He left the CCG in April this year. 

HSJ understands senior leaders at the CCG had an ambition for GPs to become salaried employees of the PCO, and for back office functions to be consolidated.

The process was paused in July this year and an independent review commissioned from Community Health Partners, which detailed numerous issues with the work that had been carried out.

Following a survey and interviews with GPs and other stakeholders, the review, which was published in the CCG’s board papers on 30 October, found:

  • there was “sometimes fierce” criticism of the previous leadership within the CCG, and lack of trust was a significant issue;
  • a “distinct feeling of confusion” on how decisions were made, particularly around the primary care strategy;
  • over half the interviewees expressed anger towards the approach to the development of the PCO, with a significant number feeling they were misled

GPs also expressed doubts over the need for a new PCO, when there was already an existing federation, Trafford Primary Health.

The review added: “It is without doubt that the CCG has been through a particularly turbulent time with a number of significant changes in leadership in the recent past.

“However, with new leadership in place a significant majority of respondents reported the development of a more altruistic ethos and an increasing optimism that real change can be made for and on behalf of the residents of Trafford…

“Involving the practices in shaping the new delivery model and giving a view as to how the CCG might support the transformation process across Trafford is a major opportunity to start a new dialogue.”

The PCO project was awarded transformation funding from Greater Manchester’s devolution team, which could still be utilised once a revised approach is agreed, the review said.

The review made several recommendations, including an “immediate stop to the development of the current PCO”, a new engagement strategy for the CCG with practices and the existing federation, and a “clear direction from the CCG as to how neighbourhoods will drive this agenda with CCG support and not a top-down approach”.

The CCG said it will carry out the recommendations, and added in a statement: “We welcome the fact that the independent review recognises the positive changes which are happening under the new leadership of [the] CCG and we note the increasing optimism in the future of the CCG.”

The CCG’s accountable officer role was filled by Dr Guest until November 2016, before being filled for six months by chief operating officer Gina Lawrence, and then for 11 months by interim Cameron Ward. It was then briefly filled by Theresa Grant, who was also chief executive of Trafford Council. But she stepped down from both roles in July 2018 and it has since been held by Anthony Hassall, who is also the accountable officer at Salford CCG.

After standing down as AO, Dr Guest was the CCG’s medical officer and PCO programme director. He left the CCG in April 2018. HSJ has been unable to reach Dr Guest for comment.