We are now constantly discussing the transition process and the programme of work we have mapped, which we need to follow to deliver the structural changes demanded by the reforms. This sits alongside the planning process, with the plan for 2012/13 shuttling back and forth between the SHA, PCT cluster, Clinical Commissioning Groups (CCGs), various key providers and Health and Well-Being Board. Then there are the contract negotiations, which people who have been involved will know, have a degree of all-consuming intensity at this time of year.
We have reduced our management costs, so we are fairly certain we now sit within the management cost envelope we are likely to have for CCGs beyond 2013. Staying within the cost envelope is dependent, primarily, on our CCGs being able to secure the commissioning support they need within the £25 per head of population they have been told they will have, without any unanticipated central top slicing—or demands. We are getting a detailed understanding of what commissioning support will cost. We are moving from “John Wayne” commissioning (“a commissioner will do what a commissioner has to do”) to costed commissioning.
This may have an unanticipated consequence. If the NHS Commissioning Board decides it wants CCGs to undertake a new initiative in-year, in addition to all that it has planned to do, then the CCG will have to find the resource to do it. If they have costed what they have to do, contracted with commissioning support, and committed their budget, they will have to ask “what do you want us not to do?” The centre will probably need to start costing the demands it makes—how much will implementing a new Any Qualified Provider contract entail? Much can be done once, centrally. However, the local specification, contract compliance, and quality monitoring will have to be resourced by CCGs—if it is to be done properly.
The discipline of determining costs is a good one. It could benefit the system by generating a better understanding of the value of good management. This led our discussions onto the financial skills the CCGs and the commissioning support organisations will need. In Lincolnshire, by 2013, it looks highly likely that we will have four CCGs serviced by a commissioning support organisation with a wider geographic footprint. Each of those organisations will be vying for the senior people with the requisite financial skills and experience. This is going to be replicated across the rest of England. Our greatest challenge isn’t going to be understanding the costs—it is going to be having enough people with the skills and experience to manage the finances.
Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.