3 results
3 - The Development and Early Operation of Clinical Commissioning Groups (CCGs)
- Edited by Pauline Allen, University of Manchester, Kath Checkland, Valerie Moran, University of Kent, Canterbury, Stephen Peckham, Canterbury Christ Church University, Kent
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- Book:
- Commissioning Healthcare in England
- Published by:
- Bristol University Press
- Published online:
- 03 March 2021
- Print publication:
- 25 March 2020, pp 35-48
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- Chapter
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Summary
Introduction
The changes introduced by the HSCA 2012 represented a substantial redistribution of responsibilities within the English NHS. This included the compulsory membership of CCGs for GPs, via their practices, which was linked to a quality payment, defined locally by the CCG, for those successfully carrying out commissioning responsibilities. The policy was intentionally permissive when first introduced, with, for example, the size and composition of CCGs not imposed. In a letter to GPs in September 2010, Sir David Nicholson, Chief Executive of NHSE stated that: ‘We would want to enable new organisations, and particularly [CCGs], to have the maximum possible choice of how they operate and who works for them. It is important that GP practices be given time and space to develop their plans to form commissioning consortia’ (Nicholson, 2010). During October 2010, groups of GPs were invited to join aspiring CCGs, with the help of local SHAs – organisations that led the strategic development of the local health service and managed PCTs and NHS Trusts (NHS Digital, 2018) – to begin to organise themselves. By June 2011, there was over 90 per cent coverage of CCGs in England. Over time the policy became more constrained, with recommendations made for CCGs not to cross LA boundaries, optimal population coverage being suggested, and maximum management budgets being set. In supporting GP practices towards CCG establishment, NHSE published guidance setting out what should be considered when putting in place the necessary arrangements (NHS Commissioning Board, 2012c). The key elements of the guidance included:
• The need to have a defined geographical footprint in order to commission for populations not registered with a GP practice.
• The need for CCGs to be established as ‘membership organisations’, with GP practices as members, collectively making decisions about how the CCG should be set up and function.
• The issues to be addressed in a constitution, including: arrangements to ensure transparency; provision to hold meetings in public; appointing an audit and a remuneration committee; arrangements for relevant subcommittees if required.
• Safeguards against conflicts of interest.
• The key issues to be considered in appointing GB members, including the appointment of lay membership along with a hospital consultant and a nurse from outside the CCG's geographical area.
5 - Commissioning Primary Care Services: Concepts and Practice
- Edited by Pauline Allen, University of Manchester, Kath Checkland, Valerie Moran, University of Kent, Canterbury, Stephen Peckham, Canterbury Christ Church University, Kent
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- Book:
- Commissioning Healthcare in England
- Published by:
- Bristol University Press
- Published online:
- 03 March 2021
- Print publication:
- 25 March 2020, pp 63-82
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- Chapter
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Summary
Introduction
Under the HSCA 2012, NHSE was responsible for commissioning primary care services. However, in 2014 CCGs were invited to volunteer to take on responsibility for commissioning services from their member GP practices in addition to their wider responsibilities for commissioning acute and community services. This chapter draws upon research into the establishment of the ‘co-commissioning’ of primary care services by CCGs, which was conducted from April 2015 to April 2017 (McDermott et al, 2018). This chapter starts by exploring the history of primary care commissioning and financing in England and discusses the broad policy objectives which underpinned this significant change in CCGs’ role and scope. It examines whether and how the policy intention works in practice and explores factors affecting development of the policy, highlighting concerns over conflicts of interest, challenges in implementing the policy and unintended consequences. For clarity, the term ‘primary care commissioning’ is employed because this is the term used throughout the relevant policy documents. While globally the term ‘primary care’ often refers to the full range of out-of-hospital services, including community nursing and so on, in the UK, for the purposes of commissioning, a distinction is usually made between primary care (including GP services, and services provided by dentists and optometrists), secondary care (including standard hospital services), community care (including community nursing and a range of community-based services such as physiotherapy, occupational therapy and so on) and specialised care (including highcost, low-volume services). Following the HSCA 2012, CCGs were responsible for commissioning secondary and community care, whilst NHSE was responsible for primary and specialised care. In this book, references to primary care services predominantly mean primary medical care provided by GPs, as these are the services at which commissioning policy has been directed.
History of primary care commissioning and financing in England
The current primary care system in England is based on GPs being the contractors to the NHS rather than employees. This system was born out of the decision made at the establishment of the NHS in 1947 (Checkland et al, 2018b). This enabled GPs to remain independent of the NHS in a legal sense (although in reality the majority of practices depended overwhelmingly on NHS income), minimising their opposition to the NHS (Lewis, 1997; Peckham and Exworthy, 2003).
Road to Nowhere? A Critical Consideration of the Use of the Metaphor ‘Care Pathway’ in Health Services Planning, Organisation and Delivery
- KATH CHECKLAND, JON HAMMOND, PAULINE ALLEN, ANNA COLEMAN, LYNSEY WARWICK-GILES, ALEX HALL, NICHOLAS MAYS, MATT SUTTON
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- Journal:
- Journal of Social Policy / Volume 49 / Issue 2 / April 2020
- Published online by Cambridge University Press:
- 24 May 2019, pp. 405-424
- Print publication:
- April 2020
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- Article
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Metaphors are inescapable in human discourse. Policy researchers have suggested that the use of particular metaphors by those implementing policy changes both influences perceptions of underlying reality and determines what solutions seem possible, and that exploring ‘practice languages’ is important in understanding how policy is enacted. This paper contributes to the literature exploring the generative nature of metaphors in policy implementation, demonstrating their role in not just describing the world, but also framing it, determining what is seen/unseen, and what solutions seem possible. The metaphor ‘care pathway’ is ubiquitous and institutionalised in healthcare. We build upon existing work critiquing its use in care delivery, and explore its use in health care commissioning, using evidence from the recent reorganisation of the English NHS. We show that the pathways metaphor is ubiquitous, but not necessarily straightforward. Conceptualising health care planning as ‘designing a pathway’ may make the task more difficult, suggesting a limited range of approaches and solutions. We offer an alternative metaphor: the service map. We discuss how approaches to care design might be altered by using this different metaphor, and explore what it might offer. We argue not for a barren language devoid of metaphors, but for their more conscious use.