Clinical Commissioning Board meeting

I am often told I need to get out more so I went along to see how my local Clinical Commissioning Group was getting on – in fact to its first proper post authorisation meeting.  I tried to be objective and to listen properly.

There were many positives.  The meeting was well run, the papers were available (though not apparently on line in advance) and the CCG itself was able to report it had been authorised without conditions.  It appeared clear that the CCG was clinically led with good GP participation and had a real commitment to patient and public involvement, two good things that ought to come out of the reorganisation.  Every board member participated in the meeting, including the 4 lay members.

There was an overwhelming sense of a new organisation trying to get its bureaucracy into shape and to find its way in the new world.  There was confidence and determination very reminiscent of the early Primary Care Trusts.

There were about 10 of us “public” present but it turned out that most were in fact connected in some way or from other NHS bodies.  There was a slot for public questions which was not fully used and the gap was filled by some speculation about the lack of public interest despite all the best efforts of the CCG.

Observations are not intended as criticisms and are anyway just my impressions.  I have been to a lot of varieties of NHS board meetings and this was better than many.  It could have been a PCT meeting – if you ignored the number of times “Dr” appeared on the name/place labels.

It was a bit insular and inward focused – there is a lot going on in the NHS, public health in transition and collapsing social care but the big national and strategic issues did not appear to have a more local dimension.

A lot of the 3 hour meeting was used to pass information to individual board members.  Reports had been tabled but questions were asked on details and answers given; no discussion and no challenge.  All of that could have been done outside the meeting – by email.

Perhaps it is too early but there was not a sense of a team and just a suggestion of a hierarchy with the professionals somehow elevated.

It was very operational and there was not much strategic context.  NHS boards used to be told meetings should be 80% strategic (they were also told many other things which contradicted that).  There was not much forward looking – for example how to plan to deal with the other parts of the commissioning cycle beyond monitoring “contracts”.

What has happened featured a lot.  But there was less about why things happened, and what things should have happened some other way.  Discussion about what is not happening is almost more important; is the balance right in how priorities are being set and how resources are allocated, is the CCG in control of things?

It was acute centred, maybe as that is the easy part for looking at information.  To their credit they did have a report about the first stab at some kind of performance measures around mental health so that did get mentioned; but nothing much about primary care, community care or social care.

A sense of an organisation not yet being taken seriously.  The main local authority made a series of excuses about why it was unable to send anyone, provide data or make progress on certain joint initiatives.  There were also vague and unspecified issues with the Commissioning Support Unit.

A sense of some bewilderment at the complexity of what they are trying to do.  There are 5 CCGs and 3 social care commissioners in our county.  The timeliest issue of great complexity, around procurement and Section 75, did not get aired; there is no obvious procurement strategy.

But it is early days and it was far better than I expected and I can only wish them well with what looks like some almost impossible challenges.