A clinician's view of the new commissioning landscape

In the first of two articles, I talked about the new commissioning landscape post 1 April 2013. In this article I would like us to consider the impact of this on some of my neighbours.

Warrington CCG was authorised in December 2012 without conditions. Responsible for commissioning services for 206,000 registered patients, we are actually funded for 198,000 as the allocation formula does not allow for the impact of new town growth. We also have a gap of 10 years in life expectancy between our inner and outer wards but the formula does not recognise this as the affluence offsets the deprivation in the formula. Additionally, the misallocation of resources for specialist commissioning has led to a very challenging local financial picture.

Our allocation for 2013/14 is £231m, which compares with others as below:

If Warrington had the North West average, we would have £32m more. If Warrington had the North average, we would have £29m more. And if Warrington had an England average, we would have £11m more.

As a town we have a higher prevalence of:

• coronary heart disease;
• dementia;
• depression; and
• chronic kidney disease.

Good health outcomes in:

• patient experience of GPs and dentists;
• incidence of MRSA and C. difficile; and
• patient-reported outcomes for knee replacements

Poor health outcomes in:

• under-75 mortality from cancer and cardiovascular disease;
• emergency admissions of alcohol-related liver disease;
• proportion of people feeling supported to manage their condition;
• unplanned hospitalisation; and
• emergency admissions not requiring hospitalisation.

Part of the community

Although only formally authorised last December, we have had full delegated authority for all commissioning since April 2010. Over this time the CCG led the local delivery of significant financial recovery plans, totalling £15m in recurrent savings, for each of two consecutive years.

‘Our success will only be measured by the people of Warrington having better outcomes’

Warrington cannot afford to be average, given the challenges it faces as a health and social care economy. We have to operate in the top 75 per cent in all aspects of our efficiency and effectiveness if we are to make best use of the resources available to us to improve health outcomes for the people of Warrington.

One of the real positives about the CCG is that the substantial majority of governing body members actually live in Warrington. As GPs again, nearly all members live in Warrington, we have a vested interest in the services provided, as we and our families are the patients receiving the services. I live on a large new housing estate called Chapelford. I have to account on a daily basis to my friends and neighbours for the services they are getting, and they are not shy in expressing their views.

Co-production across the whole-system

We have recognised that to ensure the best use of all the resources available for health and social care, we have to move towards a fully integrated health and social care system.

We have a whole-system vision: “Self-sufficient communities enjoying improved health and wellbeing and better life experiences, who, when they need them, have access to high-quality and efficient services.” To deliver this vision we have an extensive transformation programme with individual workstreams being led by CCG clinical leads and the chief executives of partner organisations overseen by a whole-system governance structure.

Our success will only be measured by the people of Warrington having better outcomes, without seeing all the “hand-offs” on their personal journey.

Dr Sarah Baker is chief clinical officer at Warrington CCG