East of England’s CCGs under the microscope

Doctors and nurses at the Norfolk and Norwich University Hospital. Photo: James Bass.

Doctors and nurses at the Norfolk and Norwich University Hospital. Photo: James Bass. - Credit: Evening News © 2009

They are a small group of people with hundreds of millions of pounds at their disposal and they hold the power over your healthcare.

But now questions are being asked about the way clinical commissioning groups (CCGs) operate and the impact their choices have on patients.

Alex Stewart, chairman of Healthwatch Norfolk, an independent patient organisation with statutory powers, said CCGs in Norfolk and Waveney have to become more 'entwined' or else he fears they will implode.

Healthcare in our area is commissioned on patients' behalf by five such CCGs: Norwich CCG, South Norfolk CCG, North Norfolk CCG, West Norfolk CCG, and Great Yarmouth and Waveney CCG.

Each CCG is made up of GP practices in each area which meet to plan and design local services, and then buy those health and care services for patients.

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Those services include emergency and non-emergency medical treatment, rehabilitation, community health and mental health services.

In other words, whether the care you receive is from a hospital, GP, mental health team, paramedic, or district nurse, it is paid for by your CCG. But while there are five CCGs in Norfolk and Waveney, there are only two in Suffolk and one in Cambridgeshire.

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'I have never understood why Norfolk has five CCGs,' Mr Stewart said.

'CCGs are talking about making cuts to save money yet each CCG has a set of chief executives, chief operating officers, and finances officers, some of whom earn more than £100,000.

'The CCGs are still very much working within their own budget-setting, which they have to do, but it makes you wonder if they merged their budgets then back-office costs could be reduced.'

During the redesign of the NHS under the 2012 Health and Social Care Act, when CCGs replaced Primary Care Trusts, GP practices were asked to form groups which they felt best represented their localities and would therefore best represent patients, prompting the birth of Norfolk's five CCGs.

Mr Stewart said he feared the 'postcode lottery' effect as CCGs are increasingly having to make financial savings, which means patients in one area may not be eligible for certain NHS services that remain available in other parts of the county.

But Lord David Prior, minister for NHS productivity whose remit includes CCG allocations, said there would always be some variations within the NHS but added he expected CCGs to work together when deciding their commissioning policy.

'The government has made it clear that the last thing the NHS needs is a re-organisation,' he said.

'We think it is better to devolve the decision-making to GPs on the grounds that they know their area best.'

• Area's CCGs work together when it makes economic and clinical sense

A spokesman for the five CCGs said Norfolk and Waveney's CCG arrangements were in step with other counties with similar population figures such as Hampshire, Kent, Nottinghamshire, and Derbyshire

'In 2011, GP practices were asked by the Department of Health to form CCGs that best suited local need.

'Local GP practices were very well-placed to say what was needed and in Norfolk the five CCGs emerged.

'There was public engagement on the geographies and a rigorous assessment process.

'Each CCG has very different populations, so having a local CCG means commissioning can be more closely tailored to local need.

'The three CCGs in central Norfolk had differing needs – Norwich has all the issues of an urban centre not seen in rural north and south; North Norfolk has a much larger retired population; South Norfolk not only has specific demographic needs but it also has long-established relationships and ways of working which suit its local area.'

The spokesman said the CCGs collaborated and shared commissioning when it made 'economic and clinical sense'.

'Where services are shared one CCG will often co-ordinate commissioning – such as South Norfolk CCG co-ordinating commissioning of the new Wellbeing Service across Norfolk and Waveney,' the spokesman said.

• CCG finances

CCGs are increasingly having to explore cutting certain services to save much-needed cash.

Bosses say increased demand, the cost of contracts, and less funding from the government are among reasons why finances are getting tighter.

Nowhere in the area is this more stark than in south Norfolk where the CCG is predicting a £6.6m deficit.

This has caused the CCG to axe IVF services and gluten-free prescriptions, consult on scrapping free hearing aids for everyone with 'mild hearing loss', and cast doubt over the future funding of six beds in All Hallows Hospital, Ditchingham.

Professor Ric Fordham, professor of applied health economics at Norwich Medical School, said the very nature of commissioning means CCGs could lose money if they need to pay for more treatment than budgeted for.

'For example if a CCG commissions hip surgery for 100 patients – but it turns out more patients need the treatment and they have complications – it will cost hospitals more to treat them and they can then go back to the CCG and say 'you didn't give us enough money',' he said.

But he hinted that the east of England seemed to get less money from central government because of the area's reputation for a high standard of living.

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