Guest Blog by Ben Tyler – Reflections on a GP and Commissioning Placement – Week 3

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This’ll be my first blog really related to the CCG aspect of my placement. It took me some time to completely get my head around how it works, and I will summarise what I currently think below.


NHS England gives each CCG an amount of money per patient in their patch each year. The CCG then chooses what to commission and agrees contracts with hospitals and other providers for different services. Much of this involves the use of tariff rates, usually set nationally. For example a hospital will receive payment from the CCG for an outpatient appointment, or an admission etc.


What I didn’t realise is that different services can attract a fee that’s a profit, or a loss to the provider. Therefore the provider is incentivised to provide more of the services that make a profit, and less those that don’t. Regardless of what is best for patients.  How can this be?


This is one of many things my naïve self was surprised about, about how the NHS works behind the scenes. With all sorts of attention going into making frontline healthcare more efficient, perhaps some scrutiny should be made into how things work from behind the scenes. Why has any of the NHS been set up in a way that isn’t putting patients at the middle of everything?


With the news just starting to hit the press about the planned hospital and ward closures in some parts of the country to cut costs, the public are shocked at such proposals. It surprises me that they haven’t been consulted before. Everyone in England knows that the NHS needs to save money, but no one knows where this is tangibly going to come from.


As each patch’s demographic and current services are different, it could’ve been reasonable for each local group to sit down and consult the local population. To explain that to save the money the government need them to save, doing X, Y and Z is the safest and best way for patients to do so, and clarify why they think this and what the alternatives are. Instead the first thing the public know about any real significant cuts is scaremongering headlines in the press. The general public were never going to like the decisions made, so why not make them be a part of the decision making process?


I understand that this can be a very ideological way of looking at things, and practically would be very difficult to implement. But if there is significant outcry once different plans are published, wont that lead to even more difficult discussion?


In practice we have moved away from paternalistic medicine and now involve the patient in decisions about their care; what’s stopping this change being implemented on a larger scale?


This blog written by Ben Tyler, 4th Year Medical Student at Sheffield University

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