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As I write this it has been less than two weeks since the UK General Election. I’m still trying to work out who ‘won’. Without being overly political, this has got me thinking. It seemed to me that the result of the election, with no one having a clear majority, presented our political leaders with an opportunity. It was an opportunity to be bold. An opportunity for each leader to say to the other  “We can’t do this on our own, and you can’t do it your own. What say we work together?” 


The alliance between the Conservative Party and the DUP is exactly this, but I think missed an opportunity for the larger, main parties to work together for the good of the country as a whole. We are left with a country divide by two-party politics. Parliament is instead set up for confrontational ‘us and them’ debate and the risk of arguments rather than agreements about how to work jointly for the betterment of the people of the UK.


This led me to reflect upon the unhelpful ‘us and them’ dynamic that has arisen in some places between commissioners and providers in the NHS. The wider system has pitted us against each other, with our respective regulators insisting upon financial controls totals being met that result in winners and losers. I blogged about this last year when I compared our negotiating to a ‘Title Fight’. ( 


For some time I have been saying that this is not a helpful approach. It is clear that neither of us can fix the NHS system wide problems on our own. We have to work together. 


Our local system is one of a few across the country that is part of the Capped Expenditure Process (CEP). You can read a news report about the CEP here: There is much I could say about the CEP, and hope to be doing so over the coming weeks and months. Not everything is positive. There are, however, some things about the CEP which have resulted in better conversations. One of the fundamental principles underlying the CEP is that we have to all ‘own’ the problem. We collectively need to acknowledge that the amount of money we have to provide care for our population is all that we have, and then together determine how we live within that fixed resource. It is no longer good enough for the hospital to be content if they have balanced their books while the CCG runs into deficit. Instead we are all responsible for achieving financial balance across the system.  


What we need locally is a coalition. We need to come together, work together, plan together. We need to put aside our differences and together ensure we are providing the best possible care for the people of the area. This cannot be about organisations looking after themselves, it has to be about organisations looking after the patients. There is no place for one-upmanship. There is no place for individual or organisation protectionism. We simply cannot afford that. If we are to continue to provide the services that the people of our area deserve then we have to put all of this aside and together work out what we need to do.  


In Westminster we now appear be led by a coming together of two political parties. Locally in Central Cheshire our health care leadership now needs to consist of a coming together of commissioners and providers across the system. These ideas are not new. I have been blogging about them for a long time. The CEP does seem to have changed things though. It has changed the approach of the regulators, who are now speaking with one voice and giving a consistent message to all parts of the system, and I hope it is beginning to bring about a greater understanding and acceptance between individuals and organisations that their own part of the system is not the only part to be looking out for.


Dr Jonathan is a GP in Swanlow Practice in Winsford, Cheshire, and Clinical Chair of NHS Vale ROyal Clinical Commissioning Group.

Follow Jonathan on Twitter @DrJonGriffiths


  1. Interesting blog – thank you. I’m interested in the link you posted to CEPs – clearly the article suggests they’re a way for NHS England, really, to cap costs:

    “Under what’s been billed as a “capped expenditure process”, NHS England and the regulator NHS Improvement are telling some trusts to stick within spending limits even if that means tough decisions on the provision of non-urgent care.”

    It’s very difficult to see that as something positive for the health service, and I’d suggest that in terms of the political analogies you draw with coalition government etc. it lends itself best to the electorate rejecting austerity – because if CEPs are anything, based on that article they’re a justification of austerity.

    I’m not sure I, as a clinician, would want to be associated with an entity – be it CEP or STP or whatever – which was solely an acronym put up as a front to justify cuts and then talk about “clinician engagement” post hoc. What’s your experience been of how that’s been handled locally? I’m interested particularly in your comments on ‘organisational protectionism’?


    1. Hi NIcholas. Thanks for taking the time to read, and for commenting. A full response would be a blog in itself, and in fact is likely to form the substance for a number of future blogs. Organisational protectionism is where I perceive individual organisations seek to ensure they remain financially sustainable potentially at the expense of other organisations. Where you have a fixed budget, if one partner secures a larger slice of the pie, then others must get less. One thing the CEP is trying to do is stop that by making everyone accountable for the overall financial position.

      One important point to make about those areas involved with a CEP – the CEP does not bring with it less money for the system, it is just a way of ensuring we all live within the resources we have been allocated. All areas are, in fact, asked to do this, regardless of whether they are part of the CEP or not.

      We are embarking upon clinical engagement now. We have presented our initial, draft and unapproved suggested plans to our Membership and further work is being planned, likewise with patients. Personally I don’t think CEPs or STPs justify cuts, they are rather mechanisms to deal with the fixed budget we have available and hopefully ensure we spend those resources in the most appropriate way possible. I would want clinicians to be involved in making those decisions.


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