Local NHS Commissioning — the upheaval begins

David Cameron

In my head, CCG may well stand for Clinical Commissioning Group, but it increasingly also stands for ‘Commissioners Coming and Going’.

Local organisations have to work with a whole range of commissioners – local authority and NHS – to keep themselves viable. With all the changes and cuts in recent years, no sooner have local services made relationships, building up their local profile and making the case for carers, than that person is off and it all starts all over again.

So now, one month in to the new arrangements for NHS Commissioning, what does this mean on the ground? A new dawn of choice and options, or chaos and confusion, or just simply no change?

Below, the CEO of one of a large Carers Trust Network Partner says how it is for them…

Well, the morning came and the biggest change to NHS commissioning did at least make BBC headline news, after the biggest changes in welfare benefits story.  April 2nd was the start of a new era of GP involvement and more locally relevant commissioning and also, hopefully, a big step towards the end of a lot of uncertainty during the 2 years since the announcement.  Am I being too optimistic, I wondered?

Our area has a large Clinical Commissioning Group with many Local Commissioning Groups (LCGs) and we have had a top level transition/shadow team for 12 months. This has meant lots of new faces, structures, Terms of Reference and priorities emerging.

Everyone’s had bigger fish to fry though, starting with their own jobs; plus high level priorities and budgets. At least the decision that many services in the budget for 2012-13 carried over to this year’s budget (including ours), took some pressure away from trying to get valuable services recognised by a new audience, quickly.

That’s still a problem throughout our voluntary sector, from talking to colleagues — who in ‘Health’ they need to see and how to do that physically, when we have no central carers lead and carers services devolve to the LCGs.

Is this because carers weren’t in their mapping? Won’t this mean losing economies of scale and synergies and replicating bureaucracy?  But the positives could be more innovative and decisive and integrated commissioning than traditionally seen in social care. Am I just trying to be optimistic?

The CCG has an action plan and the Voluntary Sector were late invitees to the Joined Up Service Transformation workshops and have made it into the top 11 priorities for the CCG. But we need to be innovative and offer more joined up and single point of access services ourselves, to succeed and be commissioned effectively. Are commissioners being too optimistic, I wonder?  Will they go elsewhere?

Two events help shape my early thinking. Our LCG-led bid to extend an existing service to all parts of the CCG fails. The new criteria are very heavily weighted at evidenced cost savings (even more than previously), but we get the feedback that “the powerbases are moving” and there’s time for “corridor lobbying” before trying again. Who, what and when?

Optimism is receding… then I hear from a former GP who attended the first Public Meeting of the Governing Body of the CCG. She detected a huge cultural shift from her early experience of trying to engage GPs as part of the ‘system’ in the  early 90s and also in the PCT with the professional executive committee of GPs in the early noughties. “These GPs seem prepared  to engage with the concept of being responsible for the population, not just  their individual practices.”

Pragmatism must be the answer. We all want the same outcomes, so must keep working – people to meet, places to go!

CEOs of Carers Trust Network Partners will be blogging for us throughout the year telling us what the changes mean on the ground. Much more to come!


May 2, 2013 - Posted by | Uncategorized


  1. Thanks very much indeed for an interesting and timely blog. It’s so useful to hear balanced ‘stories’ from the front-line like this. Keep them coming!

    Comment by John Adams | May 2, 2013 | Reply

  2. […] Local NHS Commissioning – the upheaval begins ( […]

    Pingback by Cambridge Local Health Partnership April 2013 | ccvsblog | May 2, 2013 | Reply

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