In the last week, I have managed to catch up with two old friends who are the sort of GPs who I would be delighted to look after me or my family. As I listened to them both, I empathised with the pressures general practitioners face. On top of the burden of more and more patients with co-morbidities for whom more and more is expected from general practice, GPs are expected to find time to get deeply involved in commissioning. The pressures on GPs and practices are growing and they are under strain. more…

Every two months I get to sit down with the GP Chair and Chief Operating Officer from each of the Clinical Commissioning Groups (CCGs) in Lincolnshire. Ever since the reforms were announced we have retained a focus on delivery. We have thought of the development of the CCGs as revolving around delivery. There is no point to a CCG unless it is driving delivery. At the meeting we look at delivery and the development of the CCG. more…

As part of the development of our Clinical Commissioning Groups (CCGs) the seven GP CCG chairs now have a place at the NHS Lincolnshire Board meetings.  The agenda was not particularly unusual. We were required to approve the Equality and Diversity Strategy. We had a couple of papers dealing with our legacy document and the transition planning process. There were the important performance and financial monitoring reports. It is the time of year when we present the annual governance, audit committee and annual reports and summary financial statements. We had a formal letter from the Strategic Health Authority (SHA) to note and an associated action plan (completed – in case they read this!). We reviewed the Board assurance framework, the risk management annual report, and the business continuity management update. more…

The changes the government is proposing in response to the NHS Future Forum might satisfy most of the people for some of the time but their implementation immediately struck me as posing a number of problems. Where the changes stick to principles, for instance around the NHS constitution, the role of the secretary of state, Monitor’s core duties, then they seem sensible and address many of the concerns raised as a result of the proposed legislation. more…

Suppose a pathologist was to say, “Because I am not a GP I do not belong here.” Or a GP was to say, “Because I am not a cardio-thoracic surgeon I do not belong here.” No, (paraphrasing St Paul) we are all parts of one body of medical enterprise, and the patients need different doctors at different times – sometimes more specialised and sometimes more general. more…

I was in a meeting last week with the seven chairs of the new consortia, two other executives from the new PCT cluster, and an external consultant who was giving an independent overview of the context and the challenges, and how they might be jointly and severally addressed. The content and debate was engaging and enlightening. As one of the chairs said, “I am ever more conscious of my incompetence and realise I am unconsciously incompetent as well. I want to address both those areas.”  His comment was in part, I think, shaped by our shared experience of participating in a simulation. more…

The consortia dream screeched to a halt. As I watched breakfast TV in the airport lounge on my way to the GP forum, the controversial health reforms were unravelling. The forum meeting was entitled “Commissioning Consortia: Examining the comprehensive business and clinical issues for a successful practice-led future” and suddenly, it seemed inappropriate. The health bill was going into pause, facilitated by a natural break in Parliament, and the Health Select Committee had major criticisms and suggestions. Overnight, the game had changed. more…

I chaired the specialised commissioning group last week which was fascinating (and intense work). Ranged around the table were people skilled and experienced in public health, planning, procurement, finance, and a representative of the public who brought common sense and sensible challenge. 

One of the key issues we debated was whether patient choice could be restricted. A medical colleague cited an example of a procedure which we can get done in the East Midlands for £50k but cost £250k elsewhere in England – with no difference in quality. more…

A few weeks ago I attended a conference for GPs on commissioning in the brave new world of GP consortia, proposed in the recent health bill. 

The day started with a very upbeat GP seeking to enthuse the audience of about 70 participants with a reverberating war cry: “commissioning! who’s up for it?” One hand shot up like Hermione’s from Harry Potter. A few awkward seconds passed and slowly another hand went up with a turn of the head hoping they weren’t alone. They were. Two out of 70. What a start!  more…

In a recent letter Sir David Nicholson began to make clearer how he sees the NHS commissioning board and GP commissioners working together. It is a very important letter and warrants reading very carefully. The appointment of Sir David as the Chief Executive designate of the NHS commissioning board, late last year, seemed to signal that government had realised that management of a health system, through such considerable reforms at a time of severe economic challenge, required some continuity, standardisation, and grip. more…