At the moment patients are making a lot of flippant remarks. For example: ‘Now you hold the purse strings Dr Sood, you will be flying to the Bahamas!’
“There is truth in humour, but we are custodians of the funds, not users of them,” explained Kamal Sood, one of the GPs involved with the new Nene Clinical Commissioning Group (CCG).
The changes happening to the structure of the health service on April 1 are perhaps a lot for patients to get their heads around.
To explain in simple terms, where once primary care trust managers had responsibility for funding services, public health responsibility will soon be passed to Northamptonshire County Council, and many health commissioning powers handed to local GPs and other clinicians making up CCGs.
Commissioning for specialist services within hospitals and for the Primary Care funding (which pays for GPs) will be done by NHS Commissioning Board area teams and not CCGs; an important fact to remember for those critics who accused GPs of having a potential conflict of interest as commissioners of health services.
Northamptonshire will fall under the wing of three main CCGs. As one of the largest CCGs in the country, Nene CCG will cover most of the county, including 350 GPs and 625,000 patients. The rest of the county is covered by the Corby CCG, the smallest in the country, covering an area of 67,000 patients. Oundle and Wansford will be covered by the Peterborough and Cambridgeshire CCG.
The massive Nene CCG (which commissions services for Northampton and Kettering general hospitals) is broken into eight smaller ‘Localities’, each covering a population of 75 to 80,000. Localities meet once a month to discuss commissioning issues, and patients are also involved in these discussions.
So, what is the point in all of this change and what difference will it make?
Speaking to some of the doctors and managers involved, it seems that many see the changes as a way to make it easier for the right services to be commissioned, with more input from the patients themselves.
Dr Darin Seiger, chairman of Nene CCG, said: “The whole point of the changes in the NHS is to allow the local population to determine what services are needed.
“With the old system, the decisions were made by managers on a countywide basis. It was an inadequate way of delivering services. We have taken a huge step by involving local clinicians to determine what they need.
“People could say, ‘will this get us into a postcode lottery system?’ but it gives the local population the chance to say, ‘we would like that service’.”
Dr Raffaella Poggi, Nene Locality chairman for Kettering, said: “CCGs will be able to get all practitioners together around a table to talk about clinical services. We work very closely with acute hospitals and with all the social aspects. The way that money can go further is to put the practitioners together and have them working together.”
One major aim behind this reorganisation seems to be to reshuffle the way patients are helped. It is well known that certain hospital services have an overwhelming demand for their resources. It is now the aim to commission services differently. In some cases this could mean more money going to fund district nurses, put into social care or to provide more training for practitioners in local clinics to avoid all but necessary referrals to hospital departments.
Dr Peter Wilczynski, who heads the Corby CCG, said: “The great plan is to have less reliance on hospital-based care but more reliance on general practice.”
“We have an Urgent Care Centre in Corby, which has X-rays, it does blood testing...we can manage a lot of work we used to have to send to casualty. The people going to casualty now are the ones who need the technology of an acute hospital.”
Dr Seiger is also a vice-chairman of the Northamptonshire Health and Wellbeing Board, currently called the “shadow” board until PCTs cease to exist next week. One of the board’s responsibilities has been to form a strategy which, it is hoped, will be a guideline to the commissioning of services.
As well as clinicians, this board includes politicians and lay representatives. Dr Seiger is vice-chairman alongside police commissioner Adam Simmonds and University of Northampton Vice-Chancellor Nick Petford.
The board’s chairman, Cllr Robin Brown, cabinet member for health and adult social services, said: “The board brings together the commissioners of health, social care and other elements that have an impact on well-being. The main players are health (through the CCGs), the National Commissioning Board, public health through the county council, as well as social care and services for well-being developed by the district and borough councils.”
One move forward, he feels, is the allocation of ‘personal budgets’ to allow patients with long-term conditions to manage how money is spent on their care.
He said: “One of the great benefits to come from these changes is that people with long-term health conditions will be able to have personal health budgets. This allows people to tailor their care to suit their needs.”
With so much reorganisation, Healthwatch will be in place to ensure patients’ needs are met.Healthwatch will be funded by the Department of Health via the county council and will be run as an independent social enterprise, through The University of Northampton and Northampton Volunteering Centre.
Chairman Professor William Pope (currently chairman of PCT Cluster, Northamptonshire and Milton Keynes), said: “It will hold the health system in Northamptonshire to account. If standards are not being delivered, we will ask why.”
For more information, visit www.neneccg.nhs.uk or www.corbyccg.nhs.uk.