Paul Zollinger-Read’s weekly update to the clinical commissioning group pathfinder community
So we finally have the long awaited ready reckoner! Some of you will have read about it already; it’s not exactly been a best kept secret indeed some areas had developed their own as there is clear logic in using such a tool.
What this tool is not about is the ‘S’ word: the dreaded size word. All the GP Mags keep asking for us to name the minimum size for a CCG….if only life were so easy!
The end state debate of CCGs has started, indeed it started some months back and in my patch, the East of England, we have been asking CCGs and PCTs to consider the four questions that the risk assessment set out in the draft authorisation framework. To start looking at clinical ownership, commissioning boundaries, boundaries with local authorities and size. But size is not a fixed number. We know that smaller units tend to have well developed clinical ownership, so how can these smaller units work collaboratively together, they may also decide to share functions or they may decide to federate in to one CCG.
There is no one size fits all, however the tool allows CCGs to look at what the costs for their fixed corporate structures are, the costs for clinical support and other costs that CCGs need locally. It then allows them to look at how they can start to develop commissioning support.
Whilst PCTs were effective in many aspects we need a quantum shift in commissioning if we are to achieve the improvement in clinical outcomes we seek. This requires us to look at different models of commissioning support and the running cost tool provides us with a base to start to make those decisions.
The model is not a budget setting tool and should not be considered as such.
It will allow CCGs to undertake a range of scenario modelling and most are running a scenario of £25 per head of population or £20 per head. Such scenario planning makes sense as it allows CCGs to start to develop their view of the world within these clear parameters.
The tool will flush out CCGs that do look unaffordable and these debates need to start now not in DH but out in your locality. You need to ask how do local CCGs balance the economies of scale with the likely clinical ownership at smaller levels. There are many ways to do this, which are not mutually exclusive, from sharing functions, to localities coming together under a single CCG, to having highly efficient support functions provided over a wider geographical area. The tool is constructed to allow you to look at the effect of sharing various functions between CCGs.
Most solutions depend upon developing constructive local relationships and I can’t stress enough the importance of this between CCGs.
This is a very useful tool to help you in your local considerations re. CCG end states and commissioning support development. Use it, share it and discuss the results within and between CCGs: the debate and dialogue is crucial and will help you develop local ownership of your CCG plans.
