The Five Year Forward View gives a direction to the much needed transformation in the NHS but clinical commissioning groups feel their hands are tied due to micromanagement. Practical changes at the local level can go a long way in resolving national challenges

One year ago NHS England published the forward view, which set out both the challenges faced by the NHS and how we can meet them. This was welcomed by NHS Clinical Commissioners and our members, just over 86 per cent of CCGs in England.

Our members are keen to work with local partners to look to the long term and tackle the forward view’s priorities of public health, sickness prevention, self-care, health inequality and care delivered into the community.

Heading in the wrong direction?

A year in, CCGs are just as committed to doing this. However, they are growing increasingly concerned that as it stands the NHS is going in the wrong direction and repeating the same mistakes of the past. These concerns have been reinforced by the recent news that NHS trusts in England have reported a deficit of £930m in the first three months of this financial year, highlighting that the time for quick fixes is past.

Instead we need real commitment to the whole system transformation approach that we all talk so much about.

‘CCGs are getting more and more frustrated with micromanagement by NHS England’

CCGs were set up three years ago to lead that transformation. They have made a really positive start and the possibilities for further innovative work are huge.

Yet our members are becoming more and more frustrated with micromanagement by NHS England and systems that are no longer fit for purpose. If this continues there is a real risk that CCGs will not be able to achieve the vision set out in the forward view.

This is why the NHS Clinical Commissioners have published a new document, Local Solutions to National Challenges: Delivering our Commitment to Patients. It sets out the practical changes our members tell us they need to enable them to continue to deliver high quality care for their patients while also making necessary efficiencies to ensure the NHS is sustainable.

Broadly these changes can be broken down into five themes:

1. Focus on the long term

CCGs must be allowed to focus on their role of transforming health services, not diverted by narrow short term priorities imposed from the centre. Part of this involves a reduction of the burden, frequency and duplication of short term performance reporting they are increasingly required to carry out by national bodies.

It also needs understanding that complex issues such as sickness prevention and health inequalities take time to address and cross the divide between NHS, social care and public health. This is why we are calling for a single national outcomes framework covering all three.

2. The potential of localism in the NHS

There needs to be a real recognition that diverse geographies need diverse local solutions and that a one size fits all model will not work. National government may set the principles but they should not dictate policy, leaving CCGs to choose the best healthcare for their local populations.

3. Financial stability

This is not a knee jerk demand for more money. CCGs have, as a group, always balanced their books and are acutely aware of the financial problems right across the public sector. But there are reforms that will put CCGs on more stable footing and make considerable savings.

A multi-year financial settlement, rather than the current annual allocation, for example, will enable us to invest upfront in long term interventions making savings in the following years.

There also needs to be a shift in how providers are paid. Members of NHS Clinical Commissioners feel that the tariff system still favours hospitals rather than incentivising long term prevention or community based work.

4. Value CCGs as local leaders

CCGs’ understanding of their local populations is second to none. But their vital knowledge and expertise is being submerged under a top down approach from NHS England undermining them as leaders of local healthcare. There needs to be a shift towards a more mature partnership with national bodies, rather than one in which CCGs are constantly micromanaged.

5. The tools to support intelligent commissioning

CCGs are also calling for a series of changes that will enable them to work smarter and faster, including better access to patient data to help them plan services; IT systems that work seamlessly with other parts of the health service and with social services; a workforce strategy that will provide new types of staff to deliver new types of care, and clearer, simpler rules around competition and procurement.

The future

No one underestimates the challenge of transforming our health services, but CCGs are more than capable and genuinely excited to take on this task. In the words of Nikita Kanani, chair of Bexley CCG: “Clinical commissioning can be quite breathtaking in terms of what you can do for your local population, but you need to have the freedom to do it properly. We have a great opportunity; I really don’t want to lose it.”

This sentiment is one that I wholly echo and I hope that the national bodies will take on board our messages. That way, working together we can ensure that the potential of clinical commissioning is fulfilled and the vision of the forward view achieved.

Dr Steve Kell is NHS Clinical Commissioners co-chair and chair of Bassetlaw CCG

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