The development of a strategic  board of the ccg is one aspect of developing an appropriate governance regime.  BMA, DH and NHS CB guidance give examples of potential structures, but all try to avoid being prescriptive. They do however highlight the roles which need to be covered within the overall governance framework

One major aspect is that of accountability. This is described with directions as to how this can be expected to be managed externally, and suggestions towards internal accountability. This accountability belongs individually, jointly, and corporately to the board and its members, and to the whole of the CCG.

A suggested approach to managing accountability is in transparency of activity and intentions. This is about making visible and clear to everyone what is happening and why. This technique can be applied internally, and externally.  A simple approach to this is to publish all meeting notes agendas and minutes, but this relies on individuals interested in the activities of the group looking for and understanding the material. This is only a part of a fully transparent strategy.  Other important factors would include looking out for interested parties, and involving them from the beginning in developing plans and strategies, before during and after the commissioning event.  This  type of proactive structural features of transparency are worth building into the foundations of the organisation as they encourage good practice, and are hard to insert later when other practices have become established.

The importance of transparency and proactive involvement of all parties cannot be overstated. The difficult decisions which are going to have to be taken will only be successfully implemented when everyone (all interested parties) is aware of how the decisions were reached and on what information from what sources. Those most affected need to be assured that their voices have been heard, that their views have been included, and that the decision making process has been fair and open.  Whilst the responsibility will fall on ‘members’ of the commissioning group, the consequences of its activites fall on everyone within the health economy.

 

Developing an open honest culture

The development of the constitution is the first opportunity to engage everyone in the development of the CCG. In addition to the member practices and their clinicians, we need to seek opinions from the public, and the public authority, as well as key stake holder providers and partner organisations (whether NHS, third sector or for profit organisations). This may help to ensure that in writing this key document we are as inclusive as possible, and that we begin the process of incorporating transparency.  It should help to ensure that we use inclusive language which can be drawn upon to develop the legitimacy of the organisation.

Which organisations locally are our partners in developing healthcare?

There are some partners which are more obvious and others which could be considered.

Local provider trusts include our many hospitals. We have one of the largest groups of specialist trusts outside of London, especially considering the size of our city. There is one local authority which is Liverpool city council. Each of these organisations consists of a sub network of smaller organisations and it is worth considering the level of contact appropriate for each issue and for maximum engagement.

The third sector is a complex mixture of local and national groups, which are diverse in size, aims, and consistency. Identifying large organisations is relatively easy, but transparency will involve engaging as many of these organisations as possible. Some of these organisations are involved in provision of services, others are more about representing groups in society, others are a way of connecting to people around the city.

The  ‘private sector’ ; there are many organisations which operate in Liverpool and are involved directly in healthcare, in providing services, in providing advice, in providing administrative, financial or legal support. The wider community is also involved in healthcare through its involvement of its employees, their occupational health, and the access it has to large groups of people. The influence of an organisation can also extend beyond these groups, for example the media, football clubs, and arts venues have influence across many other groups.  Involvement of private sector organisations is an essential part of an open strategy.

We also need to be looking to our neighbours within the NHS, Merseyside cluster and Chester and Wirral cluster as well as other groups who share our services such as the Isle of Man, and North Wales.

The important aim in partnership working would be in using links in the most effective way for the efficient development of the local health economy, to gain support, and ideas, and to work collaboratively as part of a National Health system.

 

Sub committees

The guidance towards establishment and the BMAs guidance suggest that there are subcommittees to perform audit/oversight and other functions. Locally we have discussed some network of localities with neighbourhoods within them to address engagement and involvement. It is important that we draw from these effectively, and don’t end up with too many or too few places for discussion to replace decision. In particular whilst representation from different constituent localities will be needed in some areas, in more activity based groups it may be useful for the committee to be represented in the locality, more than the locality in the committee

Having rushed out a health bill that no one wanted, even getting through a committee stage, it seems that the momentum has been lost. The political risk to the coalition government has become to high. This leaves GPs in a dilemma, in those areas where the changes have progressed especially. Do they continue to make the changes needed for the ‘new’ model? or can the ‘old’ model be reconstructed?

Of course this doesn’t really matter. General Practice and the NHS works best when working in an integrated fashion. Cooperation between practices to produce better primary care has always been possible and consortia are simply the new name for PBC, and PCGs. Without some of the proposed changes there may be less scope for direct involvement in managing the local health economy, but the indirect effect of GPs working together remains.

Salaried GPs, locum GPs and partners who want to be involved in local medical politics will get involved. Those who want to get on with their day to day practice will continue to receive new directions to work towards.

Of course the biggest difficulty for the consortia is going to be how to make up for a droping budget, but rising prices. Any ideas or donations please apply your local consortium.

There’s a meeting of this group at LMI next week on alcohol.

Sessional GPs are also advised of the NASGP forum on commissioning which aims to encourage their involvement in GP commissioning.

As the GP consortia develop they will have to communicate with all GPs in the area to engage them and to involve them. Without this there will be no method of moving forward with any plans they might come up with.

In order to address this some consortia have manged to develop internet based systems which allow private timely, available information and discussion. This can avoid or at least reduce the need to attend meetings which can be difficult to negotiate around a clinical workload.

West Cheshire, a first wave pathfinder consortium, has a website which is professionally setup and provides a great resource for them and others to use.

West Cheshire Consortium

The development of GP commissioning is continuing with shadow consortia emerging from the dark into the shadows. The PCT has supported the development of an interim commissioning board which has replaced the PEC. The PBC consortia are disbanding to be replaced with the shadow consotia. A single application for pathfinder status for Liverpool has been sent in.

Do you have a need for a procedure of low clinical priority, these have been defined by a group of local PCTs.

The procedures listed cover some you may predict, and some you might not.

If procedures are on this ‘banned’ list you may be able to apply for special consideration.

There are several organisations which loom over the landscape in Liverpool at present.  The most immediate is LCH which is the owner/manager of ten PCTMS practices. The Medical hierarchy here involves Dr Ewen Sim, and Dr Jim O’Connor.

The Liverpool PCT is over the whole of the health service in Liverpool at present. This involves a professional executive committee chaired by Dr John Hussey, and a Medical director Dr Margaret Goddard.

The practice based commissioning consortium of which we are a member is run by Dr Fazlani, and Mr Peter Johnstone.

Future commisioning groups could be chaired by anyone. Some places around the country are actively including salaried GPs others systematically excluding them.  Dr Rob Barnett is chair of the LMC and will also be influential in determining the course of events.

This site is for all GPs in Liverpool. It is to provide a forum for discussions around working as a GP in Liverpool.

It is publically accessible and so any one can read it, at present, if this needs to be changed in the future it can be considered.

The more it is used the more useful it will be.

It may also be useful as a place to list events, links and locums/vacancies.