The introduction of CCGs in the place of Primary Care Trusts (PCTs) marked one of the biggest structural changes in the NHS’s history.
Cambridgeshire was the precursor for the move, as influential local figures like former health secretary and current South Cambridgeshire MP Andrew Lansley pushed for change.
The county began operating a shadow CCG months before the bodies were formally adopted nationwide on April 1 last year, so now Cambridgeshire and Peterborough CCG is well established.
Dr Neil Modha is chief accountable officer – aka chief executive – of the CCG, and an acting GP at Thistlemoor Medical Centre in Peterborough.
He explained: “Our CCG is responsible for commissioning or buying the tools to care for 870,000 patients in Cambridge, Huntingdonshire, Peterborough and the Fens.
“We are the third largest CCG in the country and are responsible for providing the services that hospitals provide and services in the community, such as GPs and mental health provision. It is also our job to make sure the quality of services is optimum.
“We have a budget of £900 million of taxpayers money and need services to be as good as they can be.”
The CCG has 250 staff, most of which work under eight local CCGs – two in and around Cambridge, two in Huntingdonshire, two in the Isle of Ely and Wisbech, and two in Peterborough.
Dr Modha said: “We cover a large area so this allows us to remain a ‘local’ organisation, with our leaders in each area having strong links with their GPs and nurses.
“What motivates us all is the desire to improve our health services, and because we are clinically led by doctors and nurses who want long careers here, they are keen to see improvements made.”
In its infancy, the CCG came up with three priorities:
Address the 10-year swing in life expectancy between the poor and rich.
Improve palliative end-of-life care.
Improve services for the elderly.
It is the latter which has attracted the most attention. In July last year, Dr Modha and colleagues announced they were looking for an organisation, or partnership, to provide all services for older people and adult community services for the area.
The final four bids for the £1 billion contract are now out to public consultation, closing in late June, but the process continues to attract criticism from people who claim the plan is akin to NHS privatisation.
But Dr Modha said: “This is about us organising care for our elderly population in a better and more multidisciplinary way. Once we have completed this process we will look at how we might be able to do the same for areas like children and maternity, and mental health.
“It is not a matter of privatisation because the services will remain under NHS contract and our control, but we need to move away from the existing methods of contracting and thinking. Instead of buying for a number of people, we need to buy outcomes for patients.
“The goal has never been to cause any alarm of upset but to improve services for patients in this area. It is understandable there are concerns over such a big change in approach and that is why we are keen to hear views during the consultation.”
Money talks – no more so than in the health economy, and the statistics show Cambridgeshire to be under-funded based upon its elderly and growing population.
So Is £900 million enough?
Dr Modha responded: “The challenge has been financial. Although the Government has not made cuts to NHS budgets, the money is not keeping up with the pressures of our elderly population and growing cities and towns.
“We have had to make decisions that we feel will help in the long run.”
He added: “We have tried hard to cut down on waste, and the money we do have we are trying to direct in the best way possible – trying to do less but less better.
“We work very closely with Cambridgeshire County Council in expressing to the Government Cambridgeshire’s case for more money, both on a population basis and on a ‘fairer share’ basis.”
For more information and to take part in the older people’s programme consultation, visit cambridgeshireandpeterboroughccg.nhs.uk.
A timeline of key dates from the first year of Cambridgeshire and Peterborough CCG
1 April 2013 – CCG officially launched following a year of the organisation working as a shadow CCG.
April 2013 – One of the local CCGs, Cambridgeshire Association To Commission Health (CATCH), introduced the Acute Geriatric Intervention Service (AGIS) to respond to the needs of older people in crisis in an effort to avoid unnecessary hospital admissions.
- Work starts on tackling inequalities in Coronary Heart Disease, in partnership with a range of community and secondary care providers, local authorities and patient representatives.
The aim of the programme is to reduce premature deaths from the condition in people aged under 75.
21 May 2013 – Official public launch of the CCG at Hinchingbrooke County Park
July 2013 – Search begins for provider for Older People and Adult Community Service £1 billion contract, with the publication of a pre-qualification questionnaire.
November 2013 – Introduction of Rapid Response Service in Wisbech and Isle of Ely, which provides quick assessment and treatment in the community.
- Referral Support System introduced across the CCG. All referrals from GP practices in certain key specialities were sent to a triage team of GPs to ensure they met clinical thresholds, in order to avoid unnecessary referrals.
27 February 2014 – Public launch of the NHS 111 service in Cambridgeshire and Peterborough. The service had been running in Cambridgeshire since late 2013.
March 2014 – Shortlisted bidders for the Older People’s contract announced and public consultation launched.