Who should govern the NHS? GPs or community?

NHS Commissioning

It is good to hear the Labour Party speak of repealing the Health and Social Care Act 2012 but so far they have not said that they will change section 2. That is the governance of Clinical Commissioning Groups. We have seen CCGs, General Practitioners whose skills and interests lie with treating patients reluctantly coming to terms with their responsibilities. We should be concerned as to their interests. It is no criticism of individuals that the structure makes the members of CCGs accountable only to GP members. They are only required to consult and inform the public and patients groups. This means that they can, and sometimes will, make decisions in the interests of their own collective income or professional convenience. The issue of personal interests is also blurred when GPs have an interest in private companies bidding for contracts. GPs do a fine job as GPs and have a valuable perspective on the hospital and community health services. However, it is the role of Managers, who often have a clinical background, to deliver all the service needs according to patients’ needs and Public Health assessment of need s. Hospital doctors have an intimate knowledge of the workings of the system. Pharmacists, physiotherapists, nurses and others have expertise to contribute. Voluntary and patients’ organisations see the stresses in the system.

No one wants another massive reorganisation. All that is needed is to change the governance of CCGs. Let them be made up of nominees from the local councils who represent the communities they serve, voluntary and patients’ organisations, and professional representatives who should include a GP a hospital doctor and a nurse. The CCG staff can continue with their work but report to a broader based CCG.

The other major issue is the finances of the NHS. The Government sets the total sum but also influences its distribution. A major change has been that the distribution formula for GP practices has been changed to remove deprivation factors. Now “deprivation” is the proxy for “need”. So funds are taken from the areas with high unemployment, ethnic minorities, high incidence of diabetes, heart disease and hypertension. The beneficiaries are more affluent areas where life expectancy is longest. Deprivation factors must be restored as soon as possible to the funding formula so that GP practices can employ more doctors and nurses where they are needed.

Cllr Maggie Mansell

Chair of Croydon Health & Wellbeing Board writing in a personal capacity.