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CCGs already improving patient care

pharmafile | July 23, 2012 | News story | Sales and Marketing | CCGs, Commissioning Board, GPs, NHS, NHSCC, reforms

Clinical Commissioning Groups – the new structures set up under the Health and Social Care Act to control most of the NHS’s budget – are already improving patient care, says their representative body.

NHS Clinical Commissioners (NHSCC), a group billing itself as ‘an independent collective voice’ for CCGs, has published 12 case studies in ‘Clinical Commissioning in Action’, a report it describes as a ‘valuable snapshot’.

From April next year 212 CCGs, run largely by GPs and other health professionals, will replace the existing 152 primary care trusts.

In essence, it means local clinicians are leading on local health services with a view, for example, to taking pressure off A&E services in their area.

The NHSCC report says sharing best practice on improvements to patient care and experience will help but it insists: “None of these schemes are rocket science. Very often they are simple solutions to obvious problems.”

It cites Nene CCG near Kettering’s investment in additional training for practice nurses so they can treat patients with minor injuries in their surgeries and order X-rays without going through a doctor.

South Devon and Torbay CCG is attempting to reduce costs for outpatient appointments, many of which did not result in any treatment, by providing safe follow-up for men with raised prostate specific antigen levels.

They usually need monitoring, even if they have not had treatment for prostate cancer, and this means an outpatient visit, a wait for blood test results – and a repeat of the process in six months’ time.

Now patients can have blood tests locally and be contacted with the results, saving an estimated 1,500 outpatient appointments a year.

Meanwhile West London CCG has developed an integrated programme providing a single point of access to a range of mental health services for patients in Kensington and Chelsea.

And the report describes how the CCG for Great Yarmouth and Waveney sought to understand why many people with long-term conditions were bypassing local health facilities and going to A&E – and has ended up asking them for help in redesigning the system to encourage better use.

“This is just a glimpse of what’s possible,” said NHSCC interim president Dr Michael Dixon. “Clinical commissioning has a huge potential to bring real transformation to the NHS and better outcomes for patients.”

The organisation’s interim chair, Dr Charles Alessi, said there was a “need to celebrate the successes, however small, as these will encourage and inspire others to achieve more for their patients”.

There was significant opposition from health professionals to the creation of CCGs and suspicions as to their effectiveness remain.

Last month a survey published by Labour’s Shadow Health Team showed that 125 separate treatments, previously provided free by the NHS, have been restricted or stopped by NHS bodies including CCGs in the last two years.

Despite the NHS having to make £20 billion in efficiency savings by 2015, health minister Simon Burns said the government would not stand for restrictions coming from the need to save costs.

The NHSCC’s findings mirror those from a report by the government last February which demonstrated ways in which emerging CCGs were already benefiting patients.

Examples then included work by a Newcastle CCG which had led to the number of patients admitted to hospital with emergency respiratory problems falling by 70%, and a Wigan CCG’s redesign of stroke services which cut the average hospital stay for patients from 56 days to 12 days.

NHSCC encompasses the NAPC and the NHS Alliance and works with the NHS Confederation. The work of CCGs is overseen by the NHS Commissioning Board Authority.

Adam Hill