Are clinical commissioning groups ready to go?: With less than four months before CCGs take over from primary care trusts, just eight out of 211 have now been fully authorised. The focus will be on failings unless the system improves
The authorisation of the first clinical commissioning groups provides a window onto the state of readiness of the new NHS structures.
With less than four months to go before the CCGs formally take over from primary care trusts, just eight out of the 211 have now been fully authorised by the NHS commissioning board to begin their work. After a gruelling five-month assessment against no fewer than 119 criteria, a further 26 of the 'first wave' CCGs have been authorised with 'conditions'.
In a phrase redolent of Mao's Cultural Revolution, these deviants from the true path have been told to establish a 'rectification plan'. Some of the conditions amount to little more than adhering to a piece of guidance, but the problems in nine of the CCGs are serious enough for the board to insist on signing off remedial work.
Three more waves of CCG authorisation will follow in the new year. Many of the CCGs beset by the most serious problems are in those waves, so it is worrying that the first wave showed significant difficulties with basics such as having credible finance and service plans and effective governance.
Managers working in both PCTs and CCGs have seen many CCG boards struggle with strategic planning. PCTs were set up to cover whole populations; in some ways they had the opposite problem to that now being experienced by many CCGs.
The outgoing bodies were good at the big picture but sometimes struggled to get down to a granular understanding of population need. In contrast, GPs have a detailed understanding of the health needs of their patients and often their area, but are not used to planning across big populations.
The new commissioning support units will be crucial in supporting CCGs in analysing population needs and developing strategies to meet them. It is the GP organisations that are supposed to be in the lead, but watch out for some of the weaker CCGs ending up being led by their support units.
There are also widespread concerns about governance. Through no fault of their own, GPs leading these new organisations have been thrust into a position where they are at constant risk of conflicts of interest, but many of them don't seem to understand the critical importance of getting robust advice and establishing procedures to ensure they cannot be accused of improper conduct.
Crucially, some have not grasped the fact that it is not just whether you intend to do anything wrong that matters; it is being able to demonstrate that you are squeaky clean.
More positively, the organisations that have emerged the other side of the authorisation process have demonstrated a strong clinical focus, and are showing early signs of being ready to engage effectively with patients and communities.
This is, of course, where the new bodies should score highly. If first class clinical engagement does not come out of all this, then the reforms will have failed.
They also seem to be making progress on getting their commissioning support in place and getting to grips with how they are going to work with local partners.
The authorisation process is a reminder that the post-reform NHS will be even more centralised. It will be intensely difficult for CCGs to establish an alternative centre of gravity.
Like any new system it will require some early successes to establish credibility. It is therefore vitally important that the best CCGs can demonstrate they are doing more than merely inheriting the management of the existing system.
If they can show how they are deploying effective analysis, clinical insight, collaboration and strong leadership to make improvements in their local health economy the confidence of the entire system may well improve.
But if this doesn't happen then the story will focus on CCGs which are floundering or failing. While this will provide ammunition for the reform's opponents, it will only harm the interests of both patients and staff.
It will be fascinating to see which GP-led organisations emerge as the new system leaders and how they make a difference. Let's hope they emerge quickly. Guardian Professional.
The authorisation of the first clinical commissioning groups provides a window onto the state of readiness of the new NHS structures.
With less than four months to go before the CCGs formally take over from primary care trusts, just eight out of the 211 have now been fully authorised by the NHS commissioning board to begin their work. After a gruelling five-month assessment against no fewer than 119 criteria, a further 26 of the 'first wave' CCGs have been authorised with 'conditions'.
In a phrase redolent of Mao's Cultural Revolution, these deviants from the true path have been told to establish a 'rectification plan'. Some of the conditions amount to little more than adhering to a piece of guidance, but the problems in nine of the CCGs are serious enough for the board to insist on signing off remedial work.
Three more waves of CCG authorisation will follow in the new year. Many of the CCGs beset by the most serious problems are in those waves, so it is worrying that the first wave showed significant difficulties with basics such as having credible finance and service plans and effective governance.
Managers working in both PCTs and CCGs have seen many CCG boards struggle with strategic planning. PCTs were set up to cover whole populations; in some ways they had the opposite problem to that now being experienced by many CCGs.
The outgoing bodies were good at the big picture but sometimes struggled to get down to a granular understanding of population need. In contrast, GPs have a detailed understanding of the health needs of their patients and often their area, but are not used to planning across big populations.
The new commissioning support units will be crucial in supporting CCGs in analysing population needs and developing strategies to meet them. It is the GP organisations that are supposed to be in the lead, but watch out for some of the weaker CCGs ending up being led by their support units.
There are also widespread concerns about governance. Through no fault of their own, GPs leading these new organisations have been thrust into a position where they are at constant risk of conflicts of interest, but many of them don't seem to understand the critical importance of getting robust advice and establishing procedures to ensure they cannot be accused of improper conduct.
Crucially, some have not grasped the fact that it is not just whether you intend to do anything wrong that matters; it is being able to demonstrate that you are squeaky clean.
More positively, the organisations that have emerged the other side of the authorisation process have demonstrated a strong clinical focus, and are showing early signs of being ready to engage effectively with patients and communities.
This is, of course, where the new bodies should score highly. If first class clinical engagement does not come out of all this, then the reforms will have failed.
They also seem to be making progress on getting their commissioning support in place and getting to grips with how they are going to work with local partners.
The authorisation process is a reminder that the post-reform NHS will be even more centralised. It will be intensely difficult for CCGs to establish an alternative centre of gravity.
Like any new system it will require some early successes to establish credibility. It is therefore vitally important that the best CCGs can demonstrate they are doing more than merely inheriting the management of the existing system.
If they can show how they are deploying effective analysis, clinical insight, collaboration and strong leadership to make improvements in their local health economy the confidence of the entire system may well improve.
But if this doesn't happen then the story will focus on CCGs which are floundering or failing. While this will provide ammunition for the reform's opponents, it will only harm the interests of both patients and staff.
It will be fascinating to see which GP-led organisations emerge as the new system leaders and how they make a difference. Let's hope they emerge quickly. Guardian Professional.
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