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This is a guest blog.
Guest authors bring different perspectives and diverse voices to our blog. They do not always represent the views of The King’s Fund.


The best of times, the worst of times: a personal view from the CCG front line

John Richards is Chief Officer of NHS Southampton City CCG. John was a peer reviewer for the new report published by The King’s Fund and Nuffield Trust – Risk or reward? The changing role of CCGs in general practice

With 2015 now upon us, at NHS Southampton City Clinical Commissioning Group we look ahead confident of the groundwork we have put in, especially the relationships we have built with our partners. However the severe pressures over the holiday period are a painful reminder of the fact that the NHS is facing perhaps the greatest challenge in its history.

This year, the CCG will start to take a more active role in commissioning primary care, ensuring that services are not only safe, but fit to play their part in delivering our vision of ‘better care’, built around the integrated local teams across Southampton. This is a theme that is explored in The King's Fund's new report with the Nuffield Trust, Risk or reward? The changing role of CCGs in general practice. Doing this will be hard, but is of pivotal importance.

GP practices are increasingly finding it difficult to cope as work mounts up, staff shortages increase and partnerships come under great pressure. Many practices agree that the present model has to change, but keeping pace with current demand is challenging enough, let alone thinking clearly about and planning for a sustainable future.

These issues also pose a significant risk to wider clinical engagement. A trenchant criticism of primary care trusts (PCTs) was that they were isolated organisations run by managers. We have to learn from our history, talk honestly with our membership and provide practical support for those clinical leaders bold enough to step forward.

I remember how, as newly formed PCTs, we once espoused noble intentions about being a different kind of NHS organisation, one that was genuinely clinically led. But many quickly reverted to type – perhaps it was the demands of the ‘centre’, the sheer difficulty of making clinical leadership a reality, or perhaps it was in our DNA all along.

Whatever the reasons, in the new commissioning landscape these pressures need to be managed. In particular, we must be careful not to allow the inexorable flow of demands from national bodies for plans, briefings and strategic meetings to jeopardise the role of local leaders and the fundamental principles behind clinical commissioning. Clinical leaders need to know that they are making a difference. There is bound to be some falling away after the first flush of enthusiasm, but the impact of this can be minimised if the initial effort is followed by proper, ongoing development and support.

Some argue that CCGs face an inherent tension between their new role in commissioning primary care and being a membership organisation. This is a false dichotomy – it is, and always has been, all about putting quality of care for patients first. Others take the view that there is a risk we will turn back into PCTs. But there are real benefits too, particularly if it means getting closer to a unified health and social care budget after the fragmentation of recent years.

With money tighter than ever and some services straining under pressure, we face very difficult times. The Autumn Statement announced £1.98 billion of additional funding for the NHS in 2015/16 for all commissioners, including NHS England. However, sadly for us, and for 102 other CCGs across the country, the allocations funding formula has not worked in our favour, and we will receive none of the extra monies. We are working this through, but can only play the hand we are dealt; it is crucial that we make every penny count.

2015 is a fresh page, not a new book. There are tough times ahead but we will rise to the challenge because that’s what we are here for. Indeed, we have already made significant progress – our ambitious Better Care plan is now fully approved, our clear and compelling five year strategy fits well with the national direction of travel and is being energetically delivered, and our members say they have faith in our leadership.

As we approach the second anniversary of becoming a fully fledged CCG, we must renew our burning sense of purpose and create real clinical/managerial partnership – a sensible division of labour matched to skills, not trying to turn doctors into managers or vice versa! Our strength is in working together, and our ability to address pressures across the system is underpinned by our commitment to continue doing this, whatever the future may bring.