Update from Barbara Hakin

Welcome to the May issue of the GP and Practice Team Bulletin.

The pace is picking up now in terms of establishing clinical commissioning groups (CCGs), with ten months left until the new system goes live in April 2013.

Across the country, groups of practices have been coming together and identifying the shape and configuration of their CCG. It is a fantastic achievement that these geographies are now sorted and we have 212 proposed CCGs coming forward for authorisation in four ‘waves’ from July to November 2012.

This is a real landmark in the work to establish the new clinical commissioning system, and proposed CCGs are to be congratulated on the progress they are making. It means that every practice is part of a proposed CCG, and every proposed CCG has a date scheduled for its authorisation application. Most importantly, it means that everyone living in England will be covered by a CCG from April 2013.

It is important to emphasise that for patients registered with a GP practice, the responsible commissioner will be the CCG of which that practice is a member. For unregistered patients, the responsible commissioner will be the CCG in whose area they live. In the future, CCGs will also be responsible for ensuring access to emergency and urgent care for anyone within their geographic area at the time of need.

The new clinical commissioning system is based very firmly on three key principles: that patients in their communities should be at the heart of everything we do; that clinicians should be in the driving seat in shaping services; and that we should focus on outcomes based on sound evidence. CCGs are the cornerstone for delivery of these aspirations. GP practices know their patients and largely serve specific communities with whom the practice has had a relationship for many years. They already act as the hub of care for their patients; linking patients with other clinicians and ensuring that, through the registered list and the single, lifelong record, all the care patients receive is coordinated in one place. This model is envied around the world and is key to delivering better care, better experiences, better outcomes and improved safety. It is only logical that practices should be at the heart of determining how the range of local services can best meet their patients’ needs.

Good commissioning is mainly about bringing together all those with expertise and an interest in care to arrange the services which can deliver these quality outcomes. As a result, there is a huge responsibility on the CCG to involve patients and the public, and the full range of health and social care colleagues.

GPs and their practices are being placed centre stage in a way we have never seen previously. CCGs will only be successful if the majority of practices seize this opportunity and make the CCG their own.

CCG leaders are already emerging, trusted to oversee much of the day-to-day aspects of clinical commissioning. But without the support of the majority of their practice colleagues their task will be too great.  It is the contribution of all GPs and their practice teams, through their connection with their patients, and others who provide care, which will make the difference.

Last time I outlined the second part of the Commissioning Development Programme at the NHS Commissioning Board Authority – establishing and assessing a comprehensive range of commissioning support. This time I want to briefly cover the third part – which is about designing how the NHS Commissioning Board (NHS CB) will commission primary care services, specialised services, prison health services, military health services and some public health services. I will focus here on primary care services – specifically on GP services (although the same principles will generally apply to the commissioning of primary dental services, community pharmacy and primary ophthalmic services) – and on public health services.

Practices will be aware from previous bulletins that from April 2013 the NHS CB will be commissioning many of the GP services previously commissioned by primary care trusts (PCTs). The NHS CB will be responsible for the GMS, PMS or APMS contracts that GP practices hold for providing primary medical care – and it will have a duty to commission these primary care services in ways that improve quality, reduce inequalities, promote patient involvement, and promote more integrated care.

The NHS CB will be a single organisation and will, wherever it is appropriate to do so, take a consistent approach to managing the contract with practices, whether that be a GMS, PMS or APMS contract. CCGs have a huge part to play in driving up the quality of primary medical care but CCGs will not be performance managing primary care contracts. Over the next couple of months, and following close working with primary care, the NHS CB will be publishing a document that provides the detail of how it is going to operate locally and how primary care will be commissioned.

The NHS CB is also working with, among others, the Department of Health, Public Health England, CCGs, the NHS and local government to develop commissioning models for the £2.2 billion of preventive public health services it will commission directly.

The public health services that the NHS CB will commission directly are:

  • the national immunisation programmes
  • the national screening programmes
  • public health services for offenders in custody
  • sexual assault referral centres
  • public health services for children aged 0-5 years (including health visiting, family nurse partnerships, and much of the healthy child programme)
  • child health information systems.

Work is also in hand on developing single operating models for the commissioning of prison health, military health, and specialised services.

Clearly, there is much still to do in a relatively short space of time. But we have come a long way, and we can be optimistic that greater clinical and patient engagement will bring about the changes we need in order to keep improving the quality of care in this difficult economic environment.

There is more information on the commissioning development programme and a regular bulletin for proposed CCGs on the NHS Commissioning Board Authority’s website.

Dame Barbara Hakin

National Director of Commissioning Development

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