Beds and Herts LMC Ltd policy
Whilst understanding that there is a lot of criticism of the government’s plans for the NHS and concerns regarding potential conflicts of interest between commissioning decisions and providing for the day to day needs of patients, Beds & Herts LMC Ltd policy is to support the development of CCGs. We fully respect the views of and support all GPs whether they support the plans or not, but it is crucial that the LMC engages with the process at this critical time and, therefore, is able to influence commissioning in a constructive way for both patients and practitioners throughout Bedfordshire (including Luton) and Hertfordshire.
To date the Beds and Herts LMC has supervised and managed the elections of the Chair leaders of the commissioning groups ensuring that those who have stood have the competencies necessary to oversee such momentous changes and have the mandate from local GPs to undertake this responsible role.
We envisage that our future roles in relation to the CCGs, once they have full statutory responsibilities, will include:
- Ensuring that the voice of all GPs is heard
- Facilitating the full engagement between practices (and other stakeholders when necessary) and their CCGs
- Ensuring that governance policies of the CCGs are robust and fair and fully implemented
- Supporting practices in resolving disputes over commissioning decisions
- Supporting practices in resolving issues where the practice’s performance is deemed not to align with the CCGs’ aspirations
Clinical Commissioning Groups in Bedfordshire and Hertfordshire
Bedfordshire CCG (BCCG)
- Chair – Dr Alvin Low
- Accountable Officer – Sarah Thompson
Luton CCG (LCCG)
- Chair – Dr Nina Pearson
- Chief Officer – Nicky Poulain
East and North Herts CCG
- Chair – Dr Hari Pathmanathan
- Chief Executive – Beverley Flowers
Herts Valleys CCG
- Chair – Dr Nicolas Small
- Accountable Officer – Kathryn Magson
GPC Guidance for GPs and CCGs
The following guidance has been produced by the General Practitioners Committee (GPC) of the BMA, we would recommend that all those involved in commissioning consider reading these relatively short documents:
- The Principles of GP Commissioning – A GPC Statement in the Context of ‘Liberating the NHS
- The Role of LMCs in Supporting the Development of GP Consortia
- Sessional GPs: GP Commissioning and the Impact of the NHS White Paper
- Ensuring Transparency and Probity
- The Governance of Consortia
- Health and Wellbeing Boards
- Accountability and the New Structures
- The Authorisation Process
- Commissioning Support
- Clinical Commissioning Group Constitutions
Background to the Health and Social Care Act 2012
The concept of GPs leading the commissioning of secondary care and other services on behalf of patients isn’t new. Early in the 1990’s Kenneth Clarke, the then Health Secretary in Margaret Thatcher’s government, proposed an internal market within the NHS as a mechanism for driving down costs and improving efficiency through competition between service providers, mainly hospitals at that time. He also proposed that if GPs led the purchasing of services from these competing hospitals they would be able to purchase services tailored more to the needs of their patients. He did this through giving indicative budgets to volunteer GP practices, known at the time as ‘Fund-holding’ practices.
Subsequent governments have developed the concept of putting GPs in the driving seat for commissioning although they were unable to influence Primary Care Trusts (PCTs) until ‘Practice Based Commissioning’ was properly developed.
Equity and Excellence: Liberating the NHS
Within four months of the Conservative/Liberal Democrat coalition government taking power in 2010, it published its intentions for the future of healthcare provision and the NHS in a white paper entitled Equity and Excellence: Liberating the NHS. Central to these plans, is commissioning of services for patients being undertaken by frontline clinicians in Clinical Commissioning Groups, led by GPs. The White Paper and the subsequent Health and Social Care Bill engendered a lot of debate and criticism across the country, especially from the British Medical Association (BMA).
The Health and Social Care Bill became an Act on 29th March 2012.
The Department of Health has produced a number of summarised factsheets on different aspects of the Health and Social Care Bill.
Key principles behind the Health and Social Care Bill
The reorganisation of the NHS has been described by the David Nicholson, Chief Executive of the NHS Commissioning Board, as so large that it is ‘visible from space’! The key principles behind the Health and Social Care Bill are:
- That patients and carers are at the centre of all decision making – ‘No decision about me, without me’
- Frontline clinicians – namely those closest to the patients – take full responsibility for commissioning of secondary and other services for patients living in their area. This will be achieved by the setting up of Clinical Commissioning Groups, led by GPs but having a secondary care consultant (without a conflict of interest) and a nurse on the board, as well as two lay representatives, one of whom has responsibility for overseeing governance and probity of the CCG.
- Improving Public Health through the development of Health and Wellbeing Boards (set up by Local Authorities or County Councils) which will undertake a Joint Health Needs Assessment which will influence commissioning decisions of the CCGs. They will also be able to scrutinise commissioning decisions of the CCGs and, if necessary refer them to the NHS Commissioning Board
- Better collaboration and integration of health and social services but with continued emphasis on competition, arguably considered to drive up quality of care and improve efficiency between providers
- To save 45% on NHS management and administrative costs
Quality of service provision will be overseen by the Care Quality Commission (CQC) all providers of health care will eventually have to register with the CQC and deliver appropriate standards of care to patients.
Meanwhile Monitor, the independent regulator of NHS Foundation Trusts will be responsible for ensuring better collaboration between health providers.
The Financial Challenge – ‘The Nicholson Challenge’
The total budget of the NHS well exceeds £100 billion (8.3% GDP according to the Government Spending Review 2010). At the current rate of increase in the NHS budget, it has been projected that the NHS could reach an unacceptable level of 50% by 2050. In the current economic climate, with most public services facing significant budgetary cuts, the NHS has been promised 1% growth year on year. However, in real terms, this equates to a financial challenge the likes of which the NHS has never faced. David Nicholson, therefore, has predicted that there needs to be 4% efficiency savings in the NHS for the next 4 consecutive years – equivalent to a £20 billion saving. As if this isn’t hard enough, it comes at a time when the fastest growing group in British society is the over 75s. We are all living longer, developing more long-term illnesses for which there are more and more innovative, costly treatments. So the financial challenge, at a time of an aging population, is colloquially known as the ‘Nicholson Challenge’
And this is the challenge that has been delegated to the CCGs!
The New NHS Structure
Department of Health Documents
For further information search the Library on this website. If you are not able to find an answer to your query in this way, please contact the LMC office to see if we can help further.
Library Documents Include:
|18125||Changes from April 1st 2013|
|12589||New Commissiong Structures|
|14693||Accountability and the New Structure|
This briefing provides CCGs with information about the anticipated legal framework and encourages GPs to bear this in mind in order to develop transparent, inclusive and accountable organisations
|24290||Bedfordshire Health and Social Care System Strategic Plan 2014-2019|
Guides to help you with Commissioning
|7085||Care Quality Commission|
The CQC checks whether hospitals, care homes and care services are meeting government standards
|16122||CCG and Local Authority information packs|
Alphabetical list of CCGs and their baseline outcomes data
|23216||Central Eastern Commissioning Support Unit|
|15253||ChiMat: Fundamentals of Commissioning Health Services for Children|
This paper uses information that is readily available to look at how some primary care trusts have not only reduced admissions but commissioned services which deliver better outcomes for children and young people.
|25172||Commissioning a Good Child Health Service|
This guidance provides assistance in influencing the commissioning process for nurses who manage and lead children and young people services
|19556||Developing Commissioning Support - Towards Service Excellence|
This document outlines our plans to support the system, and especially NHS staff who currently undertake commissioning roles, to create the best possible support for CCGs
|25174||East of England GP Commissioning Network|
|14687||Ensuring Transparency and Probity|
GPC guidance to ensure the honest and transparent operation of clinically-led commissioning consortia
|10635||Equity and Excellence: Liberating the NHS|
Proposal of Coalition Governments Strategy for the NHS
|6527||Government Response to the NHS Future Forum Report|
Following the Government's listening exercise on the Health and Social Care Bill, the NHS Future Forum published their recommendations on the future for NHS modernisation. The Government published its response on 20 June, setting out the changes it intends to make in response to the recommendations. The NHS Future Forum report and the Government response are available via the link below.
|6562||Government Spending Review|
|12661||Health and Social Care Act Explained|
A series of factsheets on the Health and Social Care Act 2012 explain particular topics contained in the Act, including its key themes. They include case studies of the policy in action, or answer frequently asked questions about the topic.
|14691||Health and Wellbeing Boards|
This guidance provides an outline of the composition and keys roles of Health and Wellbeing Boards. The document also highlights issues for GPs and CCGs to consider with respect to their involvement in and relationship with their local Health and Wellbeing Board.
|19567||Liberating the NHS: An Information Revolution|
This consultation document builds on the commitments we made in the White Paper Equity and excellence: Liberating the NHS. It sets out the journey we all need to take - the public, patients, service users, carers, clinicians, practitioners, informatics professionals and health and care organisations - to change the ways in which information is managed for the benefit of all
|24465||Liberating the NHS: Commissioning for Patients|
This document, Commissioning for patients, provides further information on our intended arrangements for GP commissioning and the NHS Commissioning Board's role in supporting consortia and holding them to account. It seeks views on a number of specific consultation questions
|19564||Liberating the NHS: Greater Choice and Control|
|19560||Liberating the NHS: Increasing Democratic Legitimacy in Health|
|8252||Liberating the NHS: Legislative Framework and Next Steps |
Published in July 2010, the White Paper Equity and Excellence: Liberating the NHS outlines our vision to make the NHS a truly world class healthcare service that puts patients at its heart and clinicians in the driving seat, focused on outcomes. Following three months of consultation on its plans for the service, the Government's response published today sets out further policy development based on substantial feedback and reaffirms the strong commitment to the reforms
|18319||Liberating the NHS: Local Democratic Legitimacy in Health|
This short document, Local democratic legitimacy in health, provides further information on proposals for increasing local democratic legitimacy in health, through a clear and enhanced role for local government. Through elected members, local authorities will bring greater local democratic legitimacy to health. They will bring the perspective of local place - of neighbourhoods and communities - into commissioning plans. Local authorities can take a broader, more effective view of health improvement. They are uniquely placed to promote integration of local services across the boundaries between the NHS, social care and public health.
|23259||Liberating the NHS: Regulating Healthcare Providers|
This document, Regulating Healthcare Providers, provides further information on proposals for foundation trusts and to establish an independent economic regulator for health and adult social care. It seeks views on a number of specific consultation questions.
|18325||Liberating the NHS: Transparency in Outcomes - A Framework for the NHS|
This document, Transparency in outcomes: a framework for the NHS, provides further information on proposals for developing an NHS Outcomes Framework. It seeks views on a number of specific consultation questions.
|7086||Monitor (Independant Regulator of NHS Foundation Trusts)|
We assess whether NHS trusts can become foundation trusts. We then regulate them, making sure they are well run on behalf of patients and taxpayers.
|17429||NHS East and North Herts CCG Constitution|
|6526||NHS Future Forum Recommendations to Government|
The NHS Future Forum was launched on 6 April as part of the Government's listening exercise on the current Health and Social Care Bill. Set up as an independent group in order to pause, listen and reflect on the content of the existing Health and Social Care Bill the Forum has made a series of recommendations within the reports indicated in this link
|8175||Operating Framework for the NHS 2012/13|
The Operating Framework for the NHS in England 2012/13
|24291||Primary Care Strategy 2014-19|
|6528||Progession through Parliament of the Health and Social Care Bill|
Web link to Parliament's website to view the Bill's current progression
|25586||Proposed Next Steps Towards Primary Care Co-commissioning|
|25175||RCGP Centre for Commissioning|
Effective commissioning is based on continual analysis of a community's needs and designing, specifying and procuring services to meet these needs, within the resources available. Our Centre for Commissioning has produced a range of resources offering practical guidance for GPs.
|12539||The Development of CCGs|
This document highlights key issues for LMCs and GPs to consider over the coming months and signposts to further guidance where relevant.
|14689||The Governance of Consortia|
|14679||The Principles of GP Commissioning|
A GPC statement in the context of 'Liberating the NHS'
|14936||The Role of LMCs in Supporting the Development of GP Consortia|
Many GPs locally will be bombarded with information from interested parties, often trying to persuade them that the course of action they are recommending is in GPsâ€™ best interests. Local Medical Committees are ideally placed to provide the support that GPs, practices, consortia and even PCTs will need over the next few months of uncertainty and change. They must make sure that they maintain their position as the only local body that GPs can turn to for unbiased information, advice and support.
Last reviewed on 8th December 2015 (HB)