GP-led groups braced for more challenges after busy first year in charge of NHS purse strings
06:30 05 April 2014
Archant Norfolk 2013
The custodians of NHS purse strings received a baptism of fire after formally being handed the control of hundreds of millions of pounds on April 1, 2013.
A day later, an emergency tent was erected outside the region’s busiest Accident and Emergency department after more than a dozen ambulances queued outside the Norfolk and Norwich University Hospital.
The incident posed the first big questions to the new Clinical Commissioning Groups (CCG) in Norfolk about how they were going to help tackle ambulance delay problems and increase capacity at A&E to meet growing demand.
The GP-led groups for Norwich, North Norfolk and South Norfolk responded by pledging to plough in an extra £2.5m as part of Project Domino to pay for more than 20 new nurses and doctors within emergency care and a temporary urgent care centre was set up in one of the car parks at the N&N in January as part of a three month trial.
Ambulance delays at A&Es have dramatically reduced over the last year. However, the CCGs have come under pressure from mental health campaigners in recent months about a lack of funding for Norfolk and Suffolk NHS Foundation Trust, which is having to reduce its budget by 20pc by cutting jobs and beds.
Five CCGs for Norfolk and Waveney and two for the rest of Suffolk were put in charge of NHS funds following the abolition of primary care trusts as part of the coalition government’s Health and Social Care Act 2012.
Campaigners from 38 Degrees feared the changes would lead to future NHS contracts being handed out to private companies. Those fears appeared justified last month when a non-emergency Patient Transport Service (PTS) contract in Norfolk was awarded to private firm ERS Medical after being operated by the East of England Ambulance Service for the last eight years.
However, officials from the CCGs said that commissioning had been improved with the increased involvement of GPs in decision making and projects tailored more to the needs of local people. They added that the groups faced major challenges in the future with demands on NHS services increasing with the county’s population living longer.
Chris Price, chairman of Norwich CCG, said all NHS and social care services had worked together to improve urgent care in Norfolk over the last year.
“NHS Norwich CCG has benefited from real clinical involvement in commissioning focused on the Norwich area – which has different health needs to neighbouring areas. In the future, rising demand for services will need to be provided for within budgets which are not rising as fast. This is why we must strengthen out-of-hospital care, integrate services, look to improve the quality of care and continually look to provide good value for money,” he said.
CCGs are responsible for the commissioning of vital services such as ambulances, mental health, maternity, children’s health, rehabilitation and community health services.
Kate Gill, director of operations at HealthEast – the CCG for Great Yarmouth and Waveney – said CCGs were clearer about their priorities for local patients and carers with GPs at the helm. She added that closer working with health and social care organisations was essential.
“Demand for health services has been increasing for some time as the number of older people we care for rises. Coupled with this... we are also continuing to face financial constraints and need to use our resources very carefully. Along with our health, social care, district council and voluntary sector partners, we must change the way we work and integrate our services more closely. This will reduce duplication and make sure people get help as and when they need it from more co-ordinated and responsive services which are as close to home as possible,” she said.
CCGs across the country are responsible for £65bn of the £95bn NHS commissioning budget.
Sue Crossman, chief officer of West Norfolk CCG, said the biggest challenge was delivering expensive health services to more people within existing funding.
“At a local level this pressure is particularly acute, as we have an increasingly ageing population and a district general hospital [Queen Elizabeth Hospital in King’s Lynn] in severe financial difficulty and we need to find ways to ensure services continue to be affordable and delivered locally,” she said.
“We have ambitious plans to achieve this, working closely with health and social partners, NHS England and Monitor to design a cost effective service that provides better co-ordinated care for patients.”
Sue Vaughan, a member of the South Norfolk 38 Degrees group, said the performance was mixed.
“I think they are working very hard to try to keep services running despite the situation they have been given. What they are expected to save is unrealistic. A lot of work has gone into Project Domino, which has seen improvements. However, they have not got a handle on mental health changes, which is a disgrace.”
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