The fresh generation of CCG clinical leaders must get to grips with a raft of areas such as innovation and communication with the public if they are to be effective, writes Peter Melton
Innovation and transformation will be required
The new reformed leadership is now largely in place. How realistic will it be that these new CCG clinical leaders will succeed in responding to the challenge ahead?
‘Clinicians are keen to measure success by what’s important to measure, not what’s easy to measure’
Recent surveys have demonstrated enthusiasm, optimism and energy among their ranks. Some commentators are saying they are naive about their chance of success. What is for sure is that the new reformed system will have no chance of success without positive and inspirational leadership.
Efficiency and adoption of best practice alone will not be sufficient. Innovation and transformation will be required. The workforce and public alike will have to change their expectations and behaviour around the delivery and receipt of services. Are these newly appointed clinical leaders our best chance of success? If so, what will look different? How will the reformed system need to change to support this new leadership?
Shifting the focus from activity and performance towards quality and experience is important. Clinicians are keen to measure success by what’s important to measure, not what’s easy to measure. We need to alter the balance of priority setting from those with the greatest expectation and most powerful voice towards those with the greatest need. Clinicians want to become the voice of those they serve with the greatest amount of unmet need.
The case for clinical and GP leadership
- Confidence and support of the public Repeated surveys still place doctors and nurses as being one of the most trusted professionals.
- Unique Knowledge base As the system becomes increasingly specialised, GPs are the last professional group who have to respond to the collective needs and expectations of individuals and communities.
- Visible committed community leadership GPs and clinicians are seen as part of their community; understanding the local issues, sharing the same services and offering to be part of the required solution.
- Acceptance and ability to manage demand Through initiatives, GPs have accepted responsibility for meeting the needs of their total registered population through a discrete financial resource.
- Willingness to design pragmatic bespoke solutions Care pathways and best practice is important for the majority of circumstances but individuals and communities with the most complex problems need different solutions.
- Securing support for potential major service change Local clinicians should be best placed to make the case to their population for change for radical solutions.
They are also keen to escalate the debate about stopping services of unproven benefit. This has sparked a discussion about the potential shifting of responsibilities between national and local government, private enterprise, third sector and families. And they wish to create a dialogue around why NHS services are free irrespective of need while other services may require personal or external funding.
The need to adapt
The Health Act 2012 made explicit reference to CCGs having assumed autonomy. We will need to move from a system of performance management towards performance assurance. The new system has created more organisations and has split commissioning responsibilities between individuals, member practices, CCGs, local authorities and commissioning board.
‘CCGs need to work collectively to ensure national policymakers understand the local consequences of decisions’
At a time when we are moving towards more integration of provision we will need a new system to ensure integration of commissioning. We must be more proactive in our communication. We must describe the case of change better and work with our workforce and population to coproduce potential solutions, thereby ensuring a better chance of implementation.
For this we need a national service and workforce transformation strategy. It will be impossible for each CCG to design its own radical solution without an outline national contextual framework.
National policies that accommodate local commissioning priorities is needed. CCGs need to work collectively to ensure that national policymakers understand the potential consequences of decisions when implemented locally.
How is the system adapting to accommodate these new leaders?
We have made a good start. The system now has visible new structures and leaders. The CCG authorisation process has been helpful to create an identity for these new statutory bodies. Clinicians, GPs and member practices are beginning to understand their statutory responsibilities.
The newly established Commissioning Assembly is a unique arrangement that will be critical to making the new reforms work. If it is successful then it will reconcile the inherent tensions in the new system, it will ensure we use our collective leadership and management capacity to its greatest effect and most importantly it will support a cohesive response to the healthcare challenges at scale and pace.
Clinical leadership and the reforms to date will not be sufficient to respond to the biggest challenge the NHS has faced since its inception. We need a transformational leadership to deliver our transformed services and workforce.
This new transformational leadership will include not only the new clinical leaders but a new managerial leadership working alongside local and national public leaders. This is our next major collective imperative if we are to be successful.
Dr Peter Melton is accountable officer at North East Lincolnshire CCG
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