The major reforms stemming from the Health and Social Care Act 2012 have permeated Saturday night television, writes Dr Julia Segar. But while Clinical Commissioning Groups may have made it onto BBC One’s Casualty, a recent storyline misrepresented their ability to hold A&E departments to account; although given the complexity of the new system, this is perhaps not surprising.
A recent episode of the BBC One television drama Casualty saw Holby City’s staff in a flutter because they were expecting a visit from their local Clinical Commissioning Group.
The CCG was coming to visit to find out if the department was working efficiently. Staff members were told that the CCG were the people who now pay their salaries, so they had to make a good impression.
But it was unlikely that the watching public would be any the wiser about the role of CCGs after watching this programme; the idea that CCGs directly pay the salaries of staff in casualty departments is simply misleading. And so too is the notion that be-suited officials from the CCG would be inspecting their local A&E department.
The recent reorganisation of the health service that saw the end of Primary Care Trusts (PCTs) and Strategic Health Authorities and the birth of CCGs has placed GPs in leadership positions.
They are indeed in charge of a budget in excess of £60 billion, although this does not directly pay the salaries of the nurses and doctors in their local casualty departments. CCGs commission – in other words, they purchase – services from their local providers and this includes their local hospitals. In this sense they are interested in what goes on in their local casualty departments.
The reasoning behind these reforms is that GPs’ proximity to the frontline of patient care puts them in the best position to understand the needs of their patients. The belief is that GPs will be responsive to the needs of their local communities and their leadership roles in the new CCGs will make them more accountable to the patients that they serve. Healthcare managers have been in the firing line during this reorganisation process with many experiencing redundancy or job reallocation.
The Health Policy, Politics and Organisation Group at The University of Manchester is part of the Policy Research Unit in Commissioning and the Healthcare System, and has been researching the impact of the health reforms and looking at the early workings of CCGs.
The passage of the Health and Social Care Act 2012 into law was long and controversial and received much media attention at the time. The reorganisation that this legislation has put in train has been huge and complex and may not necessarily capture the attention and imagination of the public.
These changes are numerous; the aforementioned move from PCTs to CCGs, the transfer of public health into Local Authorities, the setting up of Health and Wellbeing Boards to set the overarching health and wellbeing strategy – within which commissioners across health, public health and social care are encouraged to work; and the birth of Commissioning Support Units to provide managerial support for clinical commissioners. In addition, the national-level bodies, NHS England and Public Health England set strategy and hold CCGs and Directors of Public Health to account.
Our research shows that GPs have embraced their new roles on CCGs. In fact GPs have been involved in commissioning for many years under different guises such as Primary Care Groups and Practice Based Commissioning.
But what has changed significantly is the complexity of the system with GPs located in a web of multiple and overlapping accountabilities. Our latest publication explores these various responsibilities.
GPs now have formal accountability to the national level bodies NHS England and Monitor, the body that regulates competition law. They are responsible for spending a large proportion of the healthcare budget and for delivering specified outcomes through standards set out in The Clinical Commissioning Group Outcomes Indicator Set.
They are also accountable to the public that they serve and furthermore they are accountable to one another. CCGs have been constituted as membership organisations that should hold each other to account.
Time will tell if this complex web of accountabilities will lead to greater levels of transparency and translate into action – or result in confusion and unintended consequences.
And while it is highly unlikely the detailed workings of CCGs will feature on prime time television any time soon, there will certainly be public interest in how healthcare budgets are spent and particularly in which services are commissioned – or more controversially – decommissioned.
- Disclaimer: The research was funded by the Department of Health via its Policy Research Programme. The views expressed in the paper are those of the authors, not the Department of Health.