Clinical Commissioning Group – Why not join one?

Dr Ian Donald, consultant geriatrician with special interest in community care, health service development and management of frailty, urges geriatricians to join a clinical commissioning group and describes his own experience of being part of a CCG. thirdSector
When Clinical Commissioning Groups (CCGs) were formed in April 2013, the legislation under the Health and Social Care Act 2012 envisaged that the CCG would be a new body built upon GP practices, which together make up the membership of the commissioning group. This “practice-led” GP commissioning was then amended to “clinically-led” commissioning. As a result, Secondary Care physicians have a statutory role on the governing body of each CCG. It was envisaged that:- “Individual members of the governing body will bring different perspectives, drawn from their different professions, roles, background and experience. These differing insights into the range of challenges and opportunities facing the CCG will, together, ensure that the CCG takes a balanced view across the whole of its business.” The regulations state that the Secondary Care Doctor should either be in practice or recently retired, and should not be an employee of an organisation which has a commissioning contract with that CCG.

The qualifications to be the Secondary Care Doctor include:
• having a high level of understanding of how care is delivered in a secondary care setting;
• competent, confident and willing to give an independent strategic clinical view on all aspects of CCG business;
• highly regarded as a clinical leader, preferably with experience working as a leader across more than one clinical discipline and/or specialty with a track record of collaborative working;
• able to take a balanced view of the clinical and management agenda, and draw on their in depth understanding of secondary care to add value;
• able to contribute a generic view from the perspective of a secondary care doctor whilst putting aside specific issues relating to their own clinical practice or their employing organisation‘s circumstances; and
• able to provide an understanding of how secondary care providers work within the health system to bring appropriate insight to discussions regarding service re-design, clinical pathways and system reform.

I applied for the post with Bristol CCG, being a neighbouring district to Gloucester, and only 45 minutes away (usually, motorway permitting!). I felt that the natural skills of the geriatrician give us an understanding and an interest in clinical pathways and whole systems of care. I have found the Governing Body very welcoming, with a band of enthusiastic GP’s complementing the managers and lay members. I have also found that they very much welcome and respect the perspective my perspective as Secondary Care representative, and all of this helps to reduce any sense of “them and us” in the Primary/Secondary care divide.
In practical terms, I am employed four sessions a month. This is not uniform, and many Secondary care members are only employed for 2 sessions. We have two governing body meetings a month, one of which is a seminar allowing exploration of one or two issues in detail. Another session is taken up in reading all the papers for the formal governing body meeting. However, after the first few months I began to feel frustrated that my involvement was limited to commenting on planned or existing services, but with little opportunity, or so it seemed, to influence the development of these. This led me to get involved in other working groups, currently one on Enhanced services to Care Homes, and the local Urgent Care Forum. Here one really starts to engage in some clinical detail.
Much of the work of a CCG is overseeing current secondary care services, mental health and community health services. Of course there is also the recommissioning of services, and the politically contentious issue of re-procurement with competitive tendering. I am only beginning to get involved in this, and there is clearly much to understand. I appreciate that some people may be very cautious about joining a CCG, because they may have a strong aversion to the notion of any possible “privatising” of clinical services. I must wait to see if this proves ethically difficult for me, but at present I have confidence that all of us on the Board have patients’ interests at the heart of our involvement.

I have written this account to encourage others to become involved when you have the opportunity. I believe there are at least 4 geriatricians on a CCG board. A network of Secondary Care members has been formed by NHS England to share our learning or frustrations. Clearly there is a potential for the work to absorb more time than paid for, and I doubt anyone will take this on for the money. I believe it is more satisfying to become involved in some of the detail, and so would encourage colleagues to take up a role where at least 3 sessions a month are offered.

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