It is good to hear the Labour Party speak of repealing the Health and Social Care Act 2012 but so far they have not said that they will change section 2. That is the governance of Clinical Commissioning Groups. We have seen CCGs, General Practitioners whose skills and interests lie with treating patients reluctantly coming to terms with their responsibilities. We should be concerned as to their interests. It is no criticism of individuals that the structure makes the members of CCGs accountable only to GP members. They are only required to consult and inform the public and patients groups. This means that they can, and sometimes will, make decisions in the interests of their own collective income or professional convenience. The issue of personal interests is also blurred when GPs have an interest in private companies bidding for contracts. GPs do a fine job as GPs and have a valuable perspective on the hospital and community health services. However, it is the role of Managers, who often have a clinical background, to deliver all the service needs according to patients’ needs and Public Health assessment of need s. Hospital doctors have an intimate knowledge of the workings of the system. Pharmacists, physiotherapists, nurses and others have expertise to contribute. Voluntary and patients’ organisations see the stresses in the system.

No one wants another massive reorganisation. All that is needed is to change the governance of CCGs. Let them be made up of nominees from the local councils who represent the communities they serve, voluntary and patients’ organisations, and professional representatives who should include a GP a hospital doctor and a nurse. The CCG staff can continue with their work but report to a broader based CCG.

The other major issue is the finances of the NHS. The Government sets the total sum but also influences its distribution. A major change has been that the distribution formula for GP practices has been changed to remove deprivation factors. Now “deprivation” is the proxy for “need”. So funds are taken from the areas with high unemployment, ethnic minorities, high incidence of diabetes, heart disease and hypertension. The beneficiaries are more affluent areas where life expectancy is longest. Deprivation factors must be restored as soon as possible to the funding formula so that GP practices can employ more doctors and nurses where they are needed.

Cllr Maggie Mansell

Chair of Croydon Health & Wellbeing Board writing in a personal capacity.

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  1. Thank you very much for writing this thought-provoking article. Have you contacted PASC in relation to their consultation finishes Friday 16 January 2015 in relation to PHSO and having possibly a new clinical review body in its place to give local assistance and remedy?

  2. Martin Rathfelder says:

    What is PASC please?

  3. This is also a bit thought provoking:

    CCG ‘donates’ practice earnings worth thousands of pounds to plug its own deficit

    13 January 2015 | By Alex Matthews-King
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    Comments (22) Save
    Exclusive The CCG facing the largest deficit in England has said it will use £460,000 of funding earned by practices through prescribing incentive schemes to plug its deficit, despite many practices already earmarking the funding for schemes to improve patient safety.

    In a letter to practices sent today, NHS Bedfordshire CCG has said that it ‘cannot defend’ spending the money while the CCG is in financial shortfall, and said ‘donating’ the funds already earned by practices instead would help speed the organisation’s financial recovery.

    But practices have said the CCG is ‘reaching into our pockets’ by taking funding which practices earned by investing considerable time and effort in schemes to reduce their prescribing bill.

    GPs have told Pulse they will lose thousands of pounds having already earmarked the funding for improving patient care, such as the purchase of new safety equipment, while others had used the funding for improving disabled access.

    Pulse reported before Christmas that NHS Bedfordshire CCG was facing a deficit of almost £30 million, which it attributed to costs of treating patients at acute hospitals, spiralling mental healthcare costs and continuing healthcare costs for treating patients in the community.

    Chief accountable and clinical officer Dr Paul Hassan said that the ‘plan for this financial year is not delivering as much as expected.’

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    Today’s letter from Dr Hassan to all CCG membership practices states: ‘As you are aware, Bedfordshire CCG has a projected end of financial year £28.8m overspend. It is a statutory obligation of all CCGs to achieve financial balance. Your executive committee has considered a number of options to ensure our overspend is no greater.’

    He added that the CCG ‘had to consider a number of highly unpalatable options’.

    He said: ‘The 2014-15 [prescribing incentive] scheme is so important to maximising value for money that this will be retained without any change. However, we hold monies on behalf of GP practices for achievements in 2012-13 and 2013-14 amounting to £460,000. Whilst this may be earmarked by practices, we cannot defend spending this money at a time when we cannot afford all of our direct patient services.

    ‘As a GP member organisation we have an opportunity to make a visible contribution to addressing the financial shortfall of our organisation. Donating the funds already earned by the prescribing incentive schemes (2012-2013 and 2013-2014) will help us to achieve our financial recovery. This will demonstrate to all providers of NHS healthcare the seriousness of the situation that we face and that GPs are at the forefront of leading the recovery.’

    One Bedfordshire GP, Dr Hubertus von Blumenthal, told Pulse that the targets are agreed with the CCG in advance, and the CCG withholds payments from the previous year once the practice has demonstrated it would be spent on ‘worthy’ causes.

    He said: ‘We have achieved these targets traditionally year on year – we are very proud on our record – and have used this reward to improve patient care in all sorts of manners, like purchasing surgical instruments to provide minor surgery, cryotherapy, etc.’

    The practice met all the criteria for the prescribing incentive scheme and was awarded £6171.28 for 2013/14, as well as having an outstanding payments of £861 due from the previous year.

    Dr von Blumenthal added: ‘We have contracted a team to improve the safety of our surgery. Equipment has been bought and we are about to present the invoices to the CCG when we learned that its responsible officer has “donated” this money earned last year to pay towards a £28.8M shortfall in his budget.

    ‘In reality the CCG responsible officer is reaching into our pockets to help fund the CCG budget deficit.’

    Dr Alex Smallwood, a Bedford GP and LMC representative told Pulse that his practice had spent their prescribing incentive achievement on improving disabled access at the practice last year, so it was only missing out on £100.

    He told Pulse: ‘We’ve actually had a look at our figures, we’ve actually only got £106 that we haven’t spent. But that’s not the point, that’s money that we would have put towards good services for patients.

    ‘And it’s work that the practice did, to earn the money in the first place, even though it’s money that’s for spending on services and improvements to your practice, that you can provide to patients.

    ‘Last year we spent ours on installing disabled access doors, which speaks for itself. So that is something – if we hadn’t already spent the money – we wouldn’t be able to have done.’

    The CCG said further action will be required to make up the overspend, and advise that if all practices ‘prioritise work on reducing use of high dose inhaled corticosteroids and greater acceptance of Scriptswitch messages’ a further £100,000 could be saved.

    It also suggests changing medication initiated in secondary care to cheaper alternatives ‘when it falls outside local formularies and guidance’.


    Anonymous | GP registrar | 13 January 2015 4:22pm

    ‘As a GP member organisation’

    Nah, can’t have it both ways. Give me the money

    Unsuitable or offensive? Report this comment
    Anonymous | GP Partner | 13 January 2015 4:30pm

    Sounds to me like the entire board of the CCG should fall on their swords and resign, if they cant manage a deficit without pickpocketing from people who had donw work in good faith.

    Unsuitable or offensive? Report this comment
    Anonymous | Sessional/Locum GP | 13 January 2015 4:36pm

  4. Martin Rathfelder says:

    Of course this approach is the opposite of what some expected to happen

  5. george says:

    I see no reason why the NHS cannot be run by both GPs and members of the public

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