Paul Zollinger-Read: Draft authorisation framework and family well-being

Paul Zollinger-ReadPaul Zollinger-Read’s weekly update to the clinical commissioning group pathfinder community.

My first week back from holiday and there has certainly been a lot going on. I suspect few of you missed the release of the draft authorization framework last Thursday. If you haven’t seen it yet please take some time to have a look; it’s an easy read. It sets out a clear direction and articulates how the road to authorization is a developmental one.

PCT and SHA clusters will work closely with developing CCGs to firstly help you determine your development needs and then to enable you to develop your skills and capacity to become excellent commissioners.

The document mentions the need for CCGs to work with SHAs undertaking a risk assessment of their readiness to start the journey to authorization. In the East of England, we are encouraging CCGs to ask themselves the following four questions:

1) Do you have the support of your practices? Ownership within any organization is crucial, without this little else will follow.
2) Do you have a clear geographical coverage, or do the practices within your group look like the flecks of pepper on a dinner plate
3) Are you co-terminus with your Local Authority; this is not black and white as I’m sure there are some areas where there will be good reasons not to be co-terminus; however the default must be that this makes commissioning, and integration of health and social care easier
4) Finally the size issue. How does your size affect your future viability?

There are various tools that can help with the size issue. There is a ready reckoner, which feeds in your local size and determines what money you have available for commissioning functions once the fixed costs of the CCG are taken into account. Clearly the smaller the CCG the relative greater effect of the fixed costs.

It is important that CCGs ask and test out these questions before they embark on the journey to authorization. It would make little sense to arrive at the time of authorization only to be rejected because there was little support from the local GPs, or the geographical coverage was not compatible with the commissioning challenge.

Let’s move now to a currently live issue and one mentioned in this week’s BMJ, that of “family well-being”. It may not be top of many agendas but as events this week have highlighted it is a crucial area that we need to focus on, and an important area where CCGs will need to work closely with local authorities.

Woody Cann, Prof Public Health Anglia Ruskin Uni discusses a recent publication from the Relationship Foundation,” the Family Pressure Gauge”. This report considers differing pressures experienced by families across 27 countries, and sadly we come 24th out of 27.Norway being at the top and Romania in 27th place.

The UK has the highest proportion of children living in workless households in the EU and the report highlights several areas that threaten family health such as the burden of debt on parents (ranked 27/27), and adolescents who get drunk repeatedly (ranked 25/27 rank). The figure here is staggering; in the UK 47% of 15 year olds have been drunk at least twice.

These are really challenging issues and multi-factorial, right at the heart of our society and we have only to look at the events last week to recognize the absolute need to address the relatively poor family well-being in the UK.

This is one of the most challenging issues for CCGs. Health and social care commissioners and the local Health and Well Being Boards must think deeply about these issues. We must learn from other societies who have higher levels of family well-being, such as the Netherlands.

Acute commissioning has had lots of attention and focus; quite rightly so; however we must remember that CCGs have an important role in helping to address the relatively poor levels of family well-being that we currently have.

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