Health Service Focus

CCG leaders working together

Greater Manchester’s 12 CCGs are continuing the partnership work done by their predecessor organisations by forming a new Association of Greater Manchester CCGs. Dr Hamish Stedman, who leads Salford CCG, will be the new association’s fi rst chairman and spoke to NHE.

Greater Manchester is the largest health economy in England outside of London, and signifi cant numbers of issues require partnership working at the city-region level. Historically, representatives from the area’s PCTs met as a cross-Greater Manchester clinical strategy board – a sub-group of the NHS GM cluster. The chairs and chief offi cers from the emergent CCGs are already familiar with working together, through that board.

The new Association of Greater Manchester CCGs – a partnership, rather than a formal organisation – is coming into being to continue the work of the previous 10 PCTs, such as on the lead commissioning arrangements for stroke care, and to provide legally-robust GM-wide governance arrangements for ongoing strategic change programmes. The new association will help ensure mutual accountability between CCGs when one leads on behalf of all.

A single voice

The 12 CCGs will also benefi t from being able to act as a single voice when dealing with the NHS Commissioning Board’s GM Local Area Team, the Association of Greater Manchester Authorities, and providers across the region.

Association chairman Dr Hamish Stedman, who leads Salford CCG, suggests that the clinicians working together through the CCGs will probably be able to bring to bear more leverage on the providers than the previous PCT cluster arrangements.

“We don’t want to squander what we’d started,” he said. “We’re all emergent organisations, and we’ve been going through a learning experience. We’ve spent a lot of time this year forging relationships between the chairs and chief offi cers, and the fi rst thing for me to do as chair is to continue that process.

“We have to try to align our planning processes as much as possible across the city, especially with the emergent CSU [Greater Manchester Commissioning Support Unit], to take the best advantage of that CSU. There are huge interdependencies in a big conurbation like Greater Manchester, so there is great sense, when we make certain decisions, in thinking about the ripple effects on our peers.

“We want to drive forward changes across the entire city. The ethos of the association is to derive the best benefi t we can from the clinical expertise that currently exists on the boards, which perhaps wasn’t always as evident as it might have been at some PCTs.”

Difficult commissioning decisions

The partnership will have 24 representatives, two from each CCG, but won’t have a commissioning budget of its own. It will instead ensure smooth and efficient collaboration between the CCGs and their individual governance arrangements.

“We’ll need to be supportive of each other,” Dr Stedman said. “There are going to be diffi cult commissioning decisions for individual CCGs, and a degree of mutual support and shared learning is going to be important.”

Inequalities

He continued: “As in any big city, there are areas of affl uence and of deprivation, and huge health inequalities across the city and within and between each CCG. Those are common problems.

“Our CCGs are slightly better-placed fi nancially than others, but we do have an acute sector that seems to have been designed in the last century, which needs to be reconfi gured to meet the needs of the 21st century population, to improve outcomes and reduce health inequalities. It’s a big industrial city and we have to try to address all of those areas.”

Commissioning post-April

We asked Dr Stedman for his view on how GPs across Salford and GM feel about the formal onset of clinical commissioning, after years of debate and preparation.

“Among the CCG leadership, we just want to get on and start doing it,” he said.

“We’ve had this ‘phoney war’, we’ve gone through authorisation, we’re now running through the last vestiges of the transition: we just want to get on. There is an appetite to commission and to use our resources to the best advantage of our population.

“There’s also a great understanding among common or garden GPs now about just what commissioning is: there may be different levels of engagement, but most GPs in my area are fully aware now of the responsibility they have not only to their individual patients, but to the population they serve at their practice and across the city.

“That maybe wasn’t the case a few years ago – realising that your clinical activity has a bearing on not just individual patients but the rest of the population as well.”

Collaborative relationships

He is keen for the association to act as a voice for Greater Manchester, and said: “There are embryonic discussions with Whitehall already about decisions affecting Greater Manchester: we’ll be a key player at those discussions.

“It would also be foolhardy not to have a collaborative relationship with the Local Area Team. There will be occasion for constructive debate, but the key word there is constructive. Just as CCGs are supporting each other, there are going to be times where the CCGs as a collective are going to want to stand shoulder to shoulder with the Local Area Team, confronting some of the difficult decisions we’ve got to make – you want them batting in your corner, not bowling against you.”

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