The difference between a PCT and a Clinical Commissioning Group – a GP Chair Perspective

Guest Blog by Darin Seiger

Darin Seiger is Clinical Chair and Accountable Officer of Nene Commissioning.  He has been GP Chair of Nene Commissioning since it was established in 2007.

I still remember the shock and disappointment I felt during the lecture in my 2^nd year of medical school when we had the session on “How the health service is actually run” – how the hell had the model evolved where managers make all of the important decisions including whether to even involve clinicians at the coal face? Madness!

Well here we are as clinicians, after years of saying we want more power and influence, ready to seize this opportunity and take these responsibilities on.  But individual clinical leaders who have grasped this vision need the support of all their local clinicians.  We have to rise to this challenge and win the hearts and minds of our generalist and specialist colleagues to work with us as a team. To do this we have to show that we mean business and that we will make a difference and not end up repeating the previous cycle of promising change and delivering the best part of bugger all.

Two years ago I called up the Medical Directors of our main provider units (two Acute, one Mental Health, one Community provider and the LMC Chair - as the provider arm of primary care) and suggested the six of us, with our combined 128 years of working in Northamptonshire, needed to start working together to provide the leadership to drive collaboration across our organisations.  We have built the crucial relationships between us, and now, through our Northamptonshire Integrated Care Partnership (NICP), we are working together to drive clinically led change though our health and social care system. 

As clinicians we can now stop asking for permission to make changes to improve the care for our patients and just get on and do it.  Implementation of our clinical ideas (‘product’) is king, and without our managerial colleagues to turn our vision into reality, we would not have the capabilities to deliver ‘product’.  We are very lucky in Nene – we have a dedicated management team that passionately believes that clinicians should make the important decisions and effectively we are committed equal partners in our determination to make change happen.

The exciting part is that as clinicians, we can break through barriers that no managerially-led system could ever do, in terms of shaping and delivering better clinical care.  We don’t need the nth degree of evidence and bureaucracy to make a decision to commission a new pathway or service because as clinicians we know they changes will deliver higher quality of care and return on our investment.  Where historically it has taken months for business cases for new services to be agreed, as clinicians we will not tolerate these delays in the system.  Ultimately we know that delays in services starting are delays suffered by our patients.

Put simply the differences between a PCT and CCG are:

·         Collaborative bottom up approaches to solving issues and designing better care for our patients whose pain and frustration we feel when things do not go right

·         Understanding that clinicians need to understand and be consulted on what the issues and potential solutions could be – it simply raises clinicians’ antibodies to be told “this is the problem and this is the solution”

·         Local leaders, with long and deeply embedded roots in our practices and communities, see ultimate success as what is achieved locally, and do not view these leadership  positions as transitional until the next opportunity comes along