Monday 28 January 2013

What does a Clinical Commissioning Group do?

One of our local Clinical Commissioning Groups is asking for our help, as members of the public, to develop a clear, concise statement that describes what they do.

The PCT cluster organised a workshop and the outcome of that event was two statements.  We are now being asked to choose which one works for us.

Well, my  answer was that neither of them do it for me.

Here are their suggestions:

Statement 1: The clinical commissioning group is your GP practices and their teams, which are responsible for buying healthcare services and working with you to improve the health of our whole community.

Statement 2: The CCG is your local doctors, their teams and the public, identifying the community's health needs and buying services to meet them. Our aim is to improve health across the county.

So here is my version:

The CCG is an NHS organisation, led by some local GPs, which is responsible for making decisions , locally, about:

  • What healthcare is provided for you,
  • Where it is provided,
  • How much is provided,
  • And the standards of care provided.
What do you think?

Can you do better?


Thursday 24 January 2013

Who should decide what healthcare we get

On April 1st,  traditionally known as April Fools Day, the UK government is implementing a major change in the way that decisions are made about what healthcare is bought and provided for us.

They have decided that some local GPs should form groups to commission some of our healthcare.For more information on these groups, called Clinical Commissioning Groups, see my blog here.

But are GPs the right people for the job? Whether they want to do the job is another question of course? Many of them are against the idea.

The reality is that they will only be taking the big strategic decisions about commissioning and giving clinical advice on what works and what does not.  The real day to day work of managing the contracts and making sure that the providers, hospitals that is, do deliver the right services, at the right time, in the right place at the agreed quality will be done by another shadowy organisation, the Clinical Support Organisations.

Should we be giving this responsibility to the GPs? They will be doing the job part time, under resourced and with little training. Most of them would rather be seeing their patients back in the surgery.  Who will be seeing those patients while they are at meetings?

So who else could do this important job?

Social care is commissioned by managers in councils under the strategic guidance from our elected councillors.  Perhaps, as suggested by the Labour Party, healthcare could be commissioned in the same way.   The newly created Health and Wellbeing Boards, due to start work on April Fools Day, will have some say in the way our healthcare is provided anyway. The trouble is are councillors and their managers any good any good at commissioning social care? Do they have the resources and the skills to do healthcare as well as social care?

In the old days the NHS was run at a local, county level by Area Health Authorities, with GPs, consultants, managers and councillors on the board.

Then there was fundholding when a limited budget was given to each GP practice to use to buy outpatients appointments and planned operations.

Then Primary Care Trusts took over the job with a few carefully selected GPs to advise managers on what to buy.

Now its back to the GPs alone.

All very confusing and uncertain.

I have no ideas who should do this vitally important job for us. Will local councillors on the Health and Wellbeing Boards be better than the PCTs and the yet to be tested CCGs?

Finally where do we, as members of the public and all of us potential service users, get a voice in the decision making process?

Tuesday 22 January 2013

A Patient's Story

I walked to the shops this morning along  the icy pavements.  On the way I met an old friend and we stopped for a gossip. We used to work together in one of the GP surgeries I worked in. We are both retired now.  After chatting about the old days, as you do, she mentioned that she was just about to have an operation.

This is a short edited version of her story of the modern NHS.

Several years ago she began to have problems with a hand.  So she went to GP.  He said  "ermmm, don't really know what is the cause but perhaps its your neck" and sent her off to the physio.  She did all the exercises the physio suggested (and I believe her) and her hand didn't get better. So back to the GP. More watchful waiting.  Finally she got an appointment with a consultant.

"I think I may have to inject your neck" he says.

"Ohh no" says my friend "Not until you check out the hand properly to see if there is another cause.

He agreed in the end and sent her off for some investigations and scans etc. As usual there was a delay of a few weeks before the investigations and then another delays (months) before a follow-up appointment with the consultants.

Amazingly the results were there at the same time she was.  "errrmm" he said.  I am still not convinced.  But she persisted and he did another examination and then sent her for some nerve conduction tests.  Another delay before the tests were done.

Then another wait before a trip to the consultant, again with test results.

"Yes" he said  " you do indeed have what you thought you had".  "You need an urgent operation as the results are very bad".

Now you may think the story ends there.  But no!

The operation required is on the 'Low Priorities List' and will only be done under exceptional circumstances.  So the consultant and GP have to write to the Primary Care Trust asking for permission to add her to the urgent waiting list. So another delay while the letter is written and the Panel reviews the request.

Luckily the PCT agreed and she will be getting the operation next month.

However in the several years that this has gone on her condition has got so bad that the operation needs to be done urgently.  It also means that her other hand has been overused and she fears it is going the same way.

This is the modern NHS.

Long delays. Treatments being rationed. Patients suffering and conditions getting worse. New barriers such as Low Priority Lists and Exceptional Circumstances reviews.

This is not good enough!