GP board members gagged under proposed CCG constitution,

http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/13213574/gp-board-members-gagged-under-proposed-ccg-constitution

Revealed: How CCGs are railroading practices into signing constitutions

http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/14655560/revealed-how-ccgs-are-railroading-practices-into-signing-constitutions

Why I quit as an NHS commissioning champion

Like many doctors I saw a chance to improve the way care is commissioned, but I won't be an instrument of privatisation

http://www.guardian.co.uk/commentisfree/2012/oct/02/why-i-quit-nhs-commissioning-champion

UK government urged over future of primary care
http://www.pharmatimes.com/mobile/12-10-02/UK_government_urged_over_future_of_primary_care.aspx

The focus of government reforms to the NHS in England must focus on how primary care services provision should be developed, rather than putting so much emphasis on its new role in commissioning, experts say.

Too little attention has been paid to how primary care will be provided in future, despite a significant problem brewing with the old "corner shop" model of general practice, according to a new report from health policy think-tank the Nuffield Trust. Its report goes on to say that this model no longer works economically for many GPs, who are struggling to meet demand and often lack the resources and organisational capacity to take on work shifted out of hospitals.

It adds, however, there is much for the new clinical commissioning groups (CCGs) and primary care providers to learn from the 20 years' experience in New Zealand, where GPs have joined forces to form strong provider organisations that are now well-placed to deliver more integrated care.

These independent practitioner organisations (IPAs) have been formed to counter-balance the government and other funders during contract negotiations, and to take collective action to improve specific areas of local healthcare, such as out-of-hours cover, prescribing, professional development for general practice and the management of chronic disease.

Their experience shows there is much value to be gained from enabling strong provider organisations rooted in general practice, says the report. For example: the IPAs have been successful in scrutinising collectively the quality of care provision, developing a wider range of practice and community services, providing infrastructure support for general practice and wider integrated care development, and encouraging peer review, it says, and identifies several lessons from the New Zealand experience that can help inform the next steps for primary care development in England.

Learning from New Zealand

First, it says, new provider networks or federations across general practice may be necessary to secure the enthusiastic engagement of a majority of GPs, which is crucial to the development of new community-based services.

Networks of GPs could choose to take the form of autonomous or private organisations which resemble more closely personal medical services (PMS), provider organisations or New Zealand-style IPAs. Such groups would literally be owned by local GPs and, not being statutory NHS bodies, they could not be swept away in any potential future NHS reorganisations. General practice networks could take informal service delivery contracts led by CCGs or the NHS Commissioning Board, within a robust framework of public commissioning and accountability, the report suggests.

Second, autonomy and independence is critical for GPs. NHS policymakers need to take account not only of the requirement for strong public accountability for devolving budgets and decisions to clinicians, but also of the importance to grassroots GPs of feeling that they can 'own' influence and benefit from any organisation to which they belong.

A possible way of enabling CCGs to co-exist with local GP provider organisations may lie in the community ownership idea that has been adopted by some New Zealand primary health organisations and IPAs - private (in the sense of non-state-owned) not-for-profit bodies, with a high degree of community and professional involvement at the governance level.

Third, the study points out, the need for strong GP engagement can initially be an obstacle to a more inclusive population health approach. The New Zealand experience suggests that, on their own, GP-led groups will struggle to bridge the divide between general practice and public health, and they will require significant time, management support and organisational development as they move through general practice priorities to focus on broader concerns such as illness prevention, proactive management of chronic disease and attention to the wider determinants of health, it says.
There is a 'strong chance' that new primary care provider organisations will turn out to be the most enduring legacy of CCGs, comments Nuffield Trust head of policy Dr Judith Smith, who co-authored the report.

She adds: "CCGs would do well to get ahead of this evidence and explore how to stimulate new general practice provider networks, which in turn could hold the answer to how to scale up primary care to manage the care of rising numbers of older people with complex conditions, at a time of economic constraint.”

Are clinical commissioning groups ready to go?

With less than four months before CCGs take over from primary care trusts, just eight out of 211 have now been fully authorised. The focus will be on failings unless the system improves

http://www.guardian.co.uk/healthcare-network/2012/dec/13/nhs-clinical-commissioning-groups

CCG chair warns Hunt A&E closure threatens ‘whole ethos of clinical commissioning’

http://www.pulsetoday.co.uk/commissioning/commissioning-topics/secondary-care/ccg-chair-warns-hunt-ae-closure-threatens-whole-ethos-of-clinical-commissioning/20001215.article#.UMpF3KyAN3A

Revealed: One in five CCG board members have potential conflict of interest

http://www.pulsetoday.co.uk/commissioning/commissioning-topics/ccgs/revealed-one-in-five-ccg-board-members-have-potential-conflict-of-interest/20001302.article#.UNb336yAN3A

Have NHS managers got the right skills?
With three CCGs recently warned, healthcare leaders must be able to engage staff and patients if they are to deliver change

http://www.guardian.co.uk/healthcare-network/2013/jan/24/nhs-managers-right-skills

How CCGs can commission to support those in poor housing
The statutory duty of CCGs to consider integration of health related services may impact the provision of housing

http://www.guardian.co.uk/healthcare-network/2013/jan/28/ccgs-commission-housing

CCG director resigns post over workload from GP contract changes

http://www.pulsetoday.co.uk/commissioning/commissioning-topics/ccgs/ccg-director-resigns-post-over-workload-from-gp-contract-changes/20002662.article#.UXMabcp5fSg

Section 75 regulations risk fragmented services http://www.fph.org.uk/section_75_regulations_risk_fragmented_services

Regulations are currently before Parliament that will govern how NHS services are commissioned. Though they have been revised, we remain concerned about the implications of the SI 500 and Section 75 provisions for competition in the health service.

The new regulations are coming into force with inadequate consultation, confusion over legal impact, and in the absence of promised guidance from Monitor even though it and Clinical Commissioning Groups (CCGs) will have to implement the regulations from 1 April 2013.

Since February 2012 FPH has expressed its concern that the imperatives of competition and choice that the Health Act 2012 introduces will:

- Prevent sound planning of health and care services,
- Lead to fragmented health services,
- Damage integration with social care and public health and
- Severely disrupt population based health programmes such as screening, immunisation and children’s and adult safeguarding.

We believe the Regulations should focus on enabling CCGs to get the best care for patients, not require them to spend taxpayers’ money on interpreting the new law and dealing with challenges from private sector companies about how services are tendered.

Improvements in eight areas "could save CCGs £1.6B+ a year" - PharmaTimes
http://www.pharmatimes.com/mobile/13-06-13/Improvements_in_eight_areas_could_save_CCGs_%C2%A31_6B_a_year.aspx

Lynne Taylor

New research shows that improvements in just eight areas of NHS activity could save England’s 212 clinical commissioning groups (CCGs) more than £1.6 billion a year, or 2.5% of current hospital spend.
The research, contained within a white paper published by consultancy MedeAnalytics, analysed statistics from a year of the Hospital Episode Statistics (HES) data sets, which cover all patient-level activity and associated costs taking place in hospitals in England. From this analysis, the researchers identified eight areas of activity that could be either improved internally by NHS Trusts or carried out closer to people's homes, thus avoiding hospital visits and associated costs. The eight areas are:
- emergency admissions with 0-1 day length of stay;
- inappropriate admissions;
- readmissions within 30 days;
- outpatient procedures carried out as inpatient same-day procedures;
- follow-up outpatients to first outpatients visits ratio;
- walk-in/inappropriate accident and emergency visits during general practitioner clinic hours;
- admissions for long-term conditions; and
- falls.

Interestingly, the data analysis found no obvious pattern in the challenge facing individual CCGs across the eight key metrics. Also, for 49 of the 212 CCGs, there was only one area in which they needed to improve.

In terms of regions, the study finds that the Midlands and East region currently has the best levels of performance overall. The London region comes second, but it is also the most varied in rankings, scoring well in some areas and poorly in others.

And the region facing the most challenges is the North, ranking worst for five of the eight indicators.

However, where an individual CCG scored poorly against a metric, other Groups in the region performed well. There is thus a significant opportunity for CCGs with areas of poor performance to use resources more effectively by understanding how their peers have tackled these challenges, the authors note.

With NHS expenditures accounting for 23% of public service spending in 2010-11, the implications for addressing this variation in performance are significant. The MedeAnalytics researchers have modelled that if every CCG achieved the average level of performance for the eight key metrics identified in the study, annual savings of £880 million - or 1.4% of total current hospital expenditure in England - are achievable.

To put this into perspective, gains on this scale would allow the NHS to achieve more than 10% of its annual savings target. Moreover, if the best (upper quartile) levels of performance were achieved everywhere, the saving should exceed £1.6 billion, 2.5% of current hospital spend, they say.

The study authors conclude that their findings offer important insights into the way NHS resources are being used in hospitals, and point out that without addressing areas of lower performance, the Service will struggle to achieve planned service improvements and better value for money. They note that while many organisations, including The King's Fund, have published lists of priorities for the new CCGs, their white paper is the first of its kind and goes one step further, in identifying eight key performance metrics and quantifying the potential impact of more consistent performance across England.

"The current spending plans that run to March 2015 are among the most challenging the NHS has delivered in any of the last 50 years, so NHS commissioners need bespoke and timely intelligence to tackle the variations they inherit," commented Anthony McKeever, one of the authors of the study and chief executive of MedeAnalytics' UK business.

"To rise to the challenges they face, CCGs must focus their resources on practices where intervention will generate the highest pay-off. This white paper offers CCGs some valuable intelligence on how to do this," he added.

Competition in healthcare doesn't have to be a case of winner takes all
Commissioners need to understand that local providers can work together and complement each other, to the benefit of patients

http://www.theguardian.com/healthcare-network/2014/jan/16/competition-commissioning-local-health-services

District nurses at risk of extinction, experts warn
District nurses are "critically endangered" and could be consigned to history in a decade unless urgent action is taken to swell their numbers, experts have warned

http://www.telegraph.co.uk/health/healthnews/10904320/District-nurses-at-risk-of-extinction-experts-warn.html