Better governance key to making NHS reforms work

Better governance key to making NHS reforms work:

Boards should strive to do the right thing and explain any variance from the rules, rather than just slavishly comply

The transition from Primary Care Trusts (PCTs) to GP-led Clinical Commissioning Groups (CCGs) envisaged in the white paper, Equality and excellence: liberating the NHS is attracting a lot of press, much of this negative.

But good things have been happening too. CCGs already demonstrate a very different risk appetite to the PCTs they will replace and we are seeing involvement of a wide range of stakeholders. We see a focus and obvious passion for commissioning integrated pathways of care closer to patients in these new devolved commissioners. Will they be allowed the freedom to get on with this? The Department of Health said so in the first consultation on the white paper

'We will not fall into the trap of prescribing top-down processes or governance requirements': many may feel this is being forgotten in the erratic passage of the government's plans, but it is an important guiding principle for devolved bodies to have the authority and responsibility to build their own structures locally that are fit for purpose.

This is consistent with modern views of good governance promoted by professor Mervyn King (the South African judge, not the chair of the Bank of England) in his King III report published by the Institute of Directors Southern Africa.

King suggests an approach to governance of "apply and explain", rather than "comply or explain". Cynics will tell you the NHS model is "comply or else" – in King's approach boards should do the right thing and explain any variance from the rules rather than slavishly comply.

King also promotes a focus on organisations explicitly defining their risk appetite to better control risk and a move to integrated reporting, all ideas being considered by the more thoughtful NHS trusts and the new CCGs.

As part of this evolution to good governance, some new CCGs are seeking to design systems built around purpose and task rather than adopting traditional NHS committee and reporting systems. We applaud this approach.

The Good Governance Institute recently identified the cycle of business requirements for PCT clusters, the newly agglomerated bodies that will see commissioning through to 2013. We identified the "must dos" and set the scene for a second piece of work for CCGs which encourages a challenge to determine locally what they should focus on and an understanding of the rhythm of board activity.

For example, May is a quieter month when contracts are signed and performance returns have not yet come in, and therefore one of those few gaps in the year to do some strategic thinking.

Miss this opportunity and the routine firefighting will soon soak up available thinking time before the summer is over. CCGs should be encouraged to use the existing cycle of business as a starting rather than end point for determining their way of working. GGI are working with CCGs in Wandsworth, Hounslow (GWCC) and elsewhere encouraging the GPs leaders to examine the tasks their predecessors have pursued and to challenge and refine their own cycle of business.

This will help create the form of good governance they need to deliver their potential.

Dr John Bullivant is the chair of the Good Governance Institute, an independent organisation supporting better governance practice. He is co-author of a guidance paper for PCTs on managing the transition to CCGs, commissioned by Allocate Software

This article is published by Guardian Professional.