In a rather mundane take on Family Fortunes we recently asked one hundred people ‘…what will be the difference between a PCT and a Clinical Commissioning Group?’ We got some surprising responses. Perhaps not as surprising as the contestant in the real Family Fortunes who was asked to name a bird with a long neck and replied ‘…Naomi Campbell’. But surprising nonetheless.
Being able to clearly articulate the difference between these two bodies and then building an organisation on the basis of this understanding is, I am currently thinking, vital to our success. If we get this right we can enable CCGs to transform healthcare in a way that no predecessor commissioning organisation has been able to. Not understanding the difference is a fast track to simply re-creating PCTs. So it is essential we get to the right answer.
So what did our respondents say? The top answer was that clinical leadership was the key to adding value to commissioning in the future; even if, for some of them, it was for mysterious, alchemical reasons. One said “…an area of real difference is that discussions will be clinically-framed around the needs of patients in a way that primarily managerial discussions seldom are”. Patients, one said, “…are the daily business of GPs but they are not the daily business of PCTs”, a point echoed more bluntly by one who added “Doctors are trusted, PCT managers are not”.
Next up was that PCTs have been monolithic dinosaurs, stifling the creativity of enthusiastic clinicians. We’re not sure how true this is but for many in our survey, the theme of empowerment and the shrugging off of the old ways is strong. “In my view,” said one, “the CCG will be a more innovative and dynamic group than the former PCT”. “CCGs will enable swifter change,” one opined, “because decisions will be built through bottom-up engagement between clinicians rather than top-down imposition from PCTs”. “PCTs have disappointed GPs by an over bureaucratic approach to contract monitoring,” suggests another, “so GPs may feel freed-up by the new arrangements and thus more able to lead clinical change”.
However, one cynic did reflect a widely held fear that “…apart from the difference in the governing body, PCTs and CCGs will just be more of the same”. Our survey said....
So, are PCTs and CCGs going to be really different? Will clinically-led commissioning revolutionise the NHS, make better use of resources and improve health outcomes? Or will it really be “…more of the same”? As Nene Commissioning progresses towards becoming a fully-functioning and authorised CCG we want to share our journey through this blog. We also want to gather more views and stimulate more debate amongst our peer organisations and others.
So, to start us off, how would you articulate, ‘…what will be the difference between a PCT and a Clinical Commissioning Group?’
Is there really going to be ANY difference? I think most of us are waiting to be convinced. With the heavy weight of the status quo and the reluctance of most GPs to get engaged I can't see how the shifts that Ben Gowland describes will even begin to be made. PCT managers are working to protect their positions, GPs are working to avoid taking any responsibility and Lansley is working to protect his job. No-one seems to be genuinely engaged in making these reforms work for patients. Or am I wrong?
ReplyDeleteThe simple truth is - GPs aren't up to it. We keep hearing that they are 'businessmen' as well as clinicians. But they run businesses with them as the only shareholder. They simply won't be able to operate as corporate beings and all the real responsibility will fall back on the managers - most of whom will be warmed over PCT managers anyway. The minute a GP has to make an unpopular decision and explain it to the Daily Mail, they'll be off back to their surgeries and the managers will be left holding the baby.
ReplyDeletePatients are the daily business of GPs ~ couldnt have said it better myself; the danger of CCGs is exactly that….decisions made on the limited amount of evidence this yields, with a far greater emphasis placed on the 'cure' agenda rather than on the prevention and holistic wellbeing one; the agenda that Wanless, Marmott and countless others have been promoting (indeed begging for) for some decades.
ReplyDeleteFor it is exactly this fear that grips health managers across the country ~ GPs know their patients, but they dont know their community. PCTs (or Public Health in local councils more pertinently it has to be said) have a great track record when it comes to engaging with the local community and assessing health (and wellbeing) needs. Cohesion, development and resilience strategies are underpinned by a strong focus on consultation and the democratic process - where Health Inequalities are only now starting to be reduced and communities mobilised. CCGs must use this learning, and not simply give us the 'patient-centred' rhetoric ad lib ...