All CCGs are considering co-commissioning primary care and some are keen to do it all.. budgets and all… We are more cautious. Co commissioning has 2 major flaws it seems to me, conflicts and capacity. We are living the issues that will inevitably arise when people start to do these things in earnest. We are re-procuring our community and out of hours services through a competitive dialogue. We want something new, innovative, joined up. Something that will bring together services and reduce duplication and waste. Our GP federation is probably going to bid. All the practices bar one single hander are in our federation therefore every GP on the governing body is conflicted.
Not everyone gets the problem. Many of my GP colleagues who manage confidentiality and potential conflicts of loyalty, information, role every day think it should be easy to sort and what is the fuss all about? But these issues are important.
We are a very open organisation we don’t really do secrets and huddles. From now on we will have to be careful who is in what conversation, who overhears what, what conversations are okay at lunch. WE eat lunch together each day.. or at least anyone who is in the building congregates in the kitchen. It is fun, social. We learn about each other as people with lives, families, interests. The chat is about all sorts but sometimes strays back to work. WE will just need to be careful we don’t talk about “some things” within the earshot of our GPs. It is important we can’t compromise them. Our weekly Strategic Management Team meeting is now divided into 2 with separate notes and minutes. The big stuff- Governing Body meetings etc. are easy enough it is the day to day that presents the challenge. AS we assess the PQQs we can’t use our usual clinical resource so will bus some GPS in who have very kindly agreed to help, from the north…This is a single project… when we commission primary care as a CCG which no doubt in the fullness of time we will all be doing it will be harder still.
Yet it is important. The public are rightly concerned about GPs making decisions about their own work and pay. Practices are concerned about in- crowds and outsiders…Everyone is concerned about fairness. Yes, CCGS understand primary care the best probably but are they best placed to make tough decisions about the services that are delivered by their friends and colleagues?
The second issue is do we have the skills and the time to do this well?...IT is a massive job. WE are doing good things but I worry that there comes a tipping point where if you take on too much you stop being able to be creative, productive and proactive and simply do nothing but fight the fires that have ignited when you were too busy to notice. And you end up running from one fire to another- exhausted, directionless. I have been there before.
Is this the right direction for primary care commissioning? I think the issues the services faces are huge and very complex. I am normally fairly good at coming up with solutions to problems…. But I struggle to even begin to find a model that will develop and invigorate primary care whilst safeguarding the pivotal role it delivers in the NHS within the structures we have today. National contracts, privately own premises, independent contractor status, financial pressures, scary workforce predictions around both recruitment and retirement, lack of leadership capability… all these conspire together to create an impending catastrophe for primary care and yet we are all sitting around watching feeling powerless to change things. Will co-commissioning be the answer? Definitely not in my view… but what will be?
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