HSJ is wrong to say we should reorganise CCGs

At the beginning of last week we heard some very unhelpful rhetoric from HSJ claiming firstly that what is really needed in the NHS is another structural reorganisation and secondly that sustainability and transformation plans can effectively be seen as replacements for clinical commissioning groups.

This wasn’t the way in which I understood STPs. Having spent much of last week at the NHS Confederation Conference speaking not just to CCG colleagues but to leaders from acute, foundation and mental health trusts, community providers and the voluntary sector, it would seem the majority of others don’t see them that way either.

At the NHS Clinical Commissioners “commissioning for the future” session held at the conference, NHS England non-executive director Lord Adebowale roundly dismissed speculation that STPs had been introduced due to a lack of confidence in CCGs, and tackled head on some of the comments made in this publication. He was adamant, as am I, that it isn’t an either/or situation.

CCGs are adapting well to the changes that are taking place, but there is nevertheless a need for something that sets out the future of clinical commissioning

STPs provide the whole system with an opportunity to make some big and bold changes to the way we deliver care, and commissioning that transformative change, with strong clinical leadership, is an essential part of that process that CCGs are there to do.

It is clear it makes absolute sense to deliver certain services at scale; but equally meeting the needs of a population at a locality level provides another challenge. CCGs are ideally placed to cope with this dichotomy of the commissioning landscape.

Of course recognising the importance of CCGs isn’t about preserving the status quo or to say there won’t be an evolution in clinical commissioning or other changes across the health and care system.

For one thing, it is has long been clear that health and social care must become more integrated: something that we have (again) called for alongside the Local Government Association, NHS Confederation and Association of Directors of Adult Social Services in our report last week Stepping up to the Place which sets out a vision of what this integration could look like.

Undoubtedly there will be situations where it is appropriate, for the benefit of patients and local populations, for CCGs, which are already working closely together, to formally merge. We are beginning to see this happen, and it is something which we should support where the benefits are clear, and the merger process does not detract from the core business of commissioning

There are also developments such as new models of care with the vanguard sites showing that positive change can happen at pace where there’s a real will to make it happen. Then there are the opportunities and challenges brought by devolution.

Future of integrated care

While these developments may lead to new ways of working, they don’t change the fact that CCGs are playing, and will continue to play, a vital role in delivering a healthier future for local populations and a better service for patients. CCGs have demonstrated over the past three years a great ability to innovate and develop services, cognisant of a local population’s needs even at times of increasing fiscal restraint.

I am a passionate believer that clinical leadership embedded within the management structure of the NHS must be supported and maintained. Having local clinicians at the heart of healthcare commissioning has already brought significant benefit and we must protect these.

The health and care landscape has changed significantly since CCGs became fully operational just over three years ago. CCGs are adapting well to the changes that are taking place, but there is nevertheless a need for something that sets out the future of clinical commissioning.

With the publication date for the long-awaited NHS England ‘CCG roadmap’ being consistently pushed backwards, NHS Clinical Commissioners is working with its members and other stakeholders to develop a vision, through the CCG lens, of what the future of clinical commissioning should look like. This we plan to publish in July.

CCGs have demonstrated over the past three years a great ability to innovate and develop services, cognisant of a local population’s needs even at times of increasing fiscal restraint

Without pre-empting the content of this publication, my own experience and what I heard at last week’s conference, shows that both for the future of CCGs and of STPs, collaboration and local relationships are key.

STPs need to be successful, in my opinion that is non-negotiable; it is therefore critical that we all pull together in the same direction. What we need is a system that supports transformation and brings commissioners and providers together to find the solutions.

Creating division between CCGs and other parts of the system and talking about whole-scale reorganisation is unhelpful particularly when we actually all want the same thing – a sustainable NHS that provides a first class service for our population.

Dr Graham Jackson is co-chair of NHSCC and clinical chair of NHS Aylesbury Vale CCG