We are working through trying to understand exactly how commissioning support (CSS) will work with Clinical Commissioning Groups (CCGs). At a recent time out the lead manager for the CSS presented on the progress being made with Greater East Midlands CSS (GEM). They highlighted the scale of work that is required with the 277 tasks in the development plan. One of the Chief Operating Officers presented the programme of work required to see through the transition from a CCG. As they pointed out, this was a transition plan—for which the work required for authorisation is a component, not the be all and end all. There is as much to do to develop the CCGs as there is to develop the CSS—and they are mutually dependent. more…

Back in May 2010 the professional executive committee and NHS Lincolnshire board agreed to delegate the management of the minor surgery local enhanced service to the practice based commissioning (PBC) Groups.  A lot of discussion and analysis had taken place prior to this decision. Practices had said that the historical budget was insufficient to meet demand and that without  investment GPs would be forced to make a referrals to hospital based services which would cost more. Concerns were raised about managing demand, the appropriateness of the surgery and whether increasing investment in primary care services would have any real impact on referrals into secondary care. Out of the debate emerged the “experiment” which the Board sanctioned. more…

In my last blog I described my time in a goldfish bowl with some 35 GPs on a leadership course—how the process worked, and what I learnt about myself, and how GPs think about me. But what I really meant to describe was our discussion on commissioning, how to do it well.

In particular, I found myself warning against “getting too close to providers.” As I explained in the last blog, one of my many faults is that I don’t know what I’m going to say until I’ve said it. One of the GPs in the “outer ring” of the goldfish bowl picked me up on this: “Did you really mean it?” It sounded so aggressive, contrasting with all the cosy talk of integration. more…

I walked into a room recently which was jam packed with secondary care clinicians and managers. I was the lone commissioner. The meeting was a peer review visit to support the development and improvement of vascular services. I recognised the chair. We had both sat together in an ante room awaiting interviews for a senior registrar job over twenty years ago! He is now a professor and I am, allegedly, a bureaucrat. more…