If you have read my previous blogs you will be aware that we are proposing to merge the four CCGs in Cheshire. When presenting this to our local GPs they have many questions, all of which are relevant and important to answer. A key question that always gets asked is around what difference it will make. In particular, what difference will it make for the GPs themselves, and more importantly for their patients.
At the end of the day, if we are unable to answer this fundamental question and deliver benefits from the merger, then we may as well not bother.
So, why are we doing it?
There are a number of reasons, all of which are valid, and all of which need to be understood.
Developing Integrated Care Partnerships
On the face of it I can see why people would question why a change of commissioner would result in things being better for the patients we serve. We are, however, trying to do so much more than merge four CCGs in our proposal. What we actually want to do is to transform the commissioning landscape across Cheshire, and create two Integrated Care Partnerships (ICPs) as well. The merger of the CCGs is intended to then release resource into these ICPs in terms of staff to work within them, and ultimately we would be looking to devolve monies to the ICPs, commissioning them to provide the care needed for their populations. This is hugely significant. This is what we have been looking to do for many years – to bring together providers to work together with the patient at the heart of the decision making. The ICPs will be a partnership between Primary and Community Care, Secondary Care, Mental Health and Local Authority. We want to get rid of the gaps that appear between services that patients can so easily fall into. We want to identify people at risk of hospital admission and proactively address their needs. We want to work across the services in a seamless way as part of a larger team – likely to be town-based.
The CCGs merging must be seen in this context. Failure to gain agreement to merge risks failure to develop our ICPs. Putting it another way, merging the CCGs enables the further development of the ICPs.
Developing Care Communities
A key element of our ICPs will be the development of our Care Communities. These already exist in their embryonic form. We have networks of GP practices coming together across towns working alongside wider stakeholders to look at health and care in a different way. I really believe that Care Communities will be where we need to be engaging in the future to improve health outcomes and improve quality of life for our patients.
More efficient commissioning
Patient care is also the end result of the commissioning work that takes place at the CCGs. The merger is intended to streamline this, reduce inefficiencies, coordinate and align services and reduce unnecessary variations in service provision. All of this should bring about benefits for our patients as a better functioning commissioning organisation leads to a better functioning healthcare system, and then to better outcomes.
Increased ability to speak up for our area
A larger CCG has a louder voice. We are talking about merging into a CCG that will cover a population of around 750,000 patients with a budget over £1 billion. This gives us the ability to shout up loudly for our patients. We are part of a large Health and Care Partnership (formerly known as the STP). Representing three quarters of a million people at that forum enables us to have a significant say on the services being discussed and the allocation of resources. We will be in a much better place to argue for local services for local people that will make a difference.
More money for patients?
Within the last 2 weeks CCGs have all received a letter detailing the expectation that they will reduce their running costs by 20% in order to use these monies for patient care. The detail around this has not yet been released, but one way of interpreting this is to assume that if we make the 20% reduction, we can move this money and spend it on services for patients. Merging our CCGs will help us to manage this 20%. There is the tantalizing possibility, therefore, that we can move this saving into increased resources for local services. To be clear – this is not why we are merging, and we didn’t even know about the 20% ‘ask’ until the last couple of weeks.
What’s the bottom line
From my perspective, the merger and creation of the two ICPs is essential. I have blogged about this previously, and also about Care Communities (links below). If we want to make changes (for the better) for our local population, then we should proceed with this. If we want to keep moving forwards and do things differently from a commissioning perspective, then we should proceed with this. If we want to bring our health and care providers together to work for our patients and integrate services, then we should proceed with this.
As we move forwards with this it is clear that ongoing communication and reinforcement of the ‘case for change’ will be helpful. I’m sure this won’t be my last word on the subject!
Dr Jonathan is a GP at Swanlow Surgery in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group
Got a question for Jonathan? Make a comment below or find him on Twitter @DrJonGriffiths