6.1 The Chair introduced Andrew Bland; Managing Director of the Business Support Unit (BSU) & Dr Amr Zeineldine, Chair of the Clinical Commissioning consortia.
6.2 The managing director commented that since they last came to the committee the essential elements remain; clinical commissioning and the savings that need to be made. As a result of the ‘pause’ it is likely that it will move to ‘clinical commissioning' rather than ‘G.P’ commissioning.
6.3 The managing director went through the presentation tabled at the meeting. The current arrangements involve all 47 practices and the area is co terminus with the London Borough of Southwark.
6.4 Southwark is a pathfinder. Dr Amir Zeineldine chair's the consortia committee; however the accountable body remains Southwark NHS. There will be increasing levels of delegated responsibility as accountability moves to the consortia.
6.5 The national commissioning body will be looking at the authorization process. As a result of the pause we will not be held to the April 2013 date, this is now more of a target than a deadline.
6.6 Dr Amr Zeineldine reported that they have clear views about how conflicts of interest are managed. If you look at the clinical leads (on the slide) it details the corporate governance role. He reported that patient and public involvement is a key area and they will be building on the existing patient groups.
6.7 It was reported that working on the ‘integration’ agenda is hugely important. They are working closely with the local authority and the Kings health partners; the three acute trusts. It is very important that they are co terminus with Southwark; but also very important that they work in partnership with Lambeth and Lewisham.
6.8 The chair asked if the enormous number of parliamentary amendment to the bill would fundamentally change the original plans. The managing director responded that we have some constants; clinical commissioning and 0 % growth. We have been asked to make a further cut of £56 per head to bureaucracy – also known as administration and planning. Cuts will need to be made, however clinical commissioning will be leading. While there will be a change in the details, the fundamentals will remain.
6.9 A member asked what you the clinical commissioning consortia will be doing to preserve skills. Dr Amr Zeineldine responded that there is a corporate memory of setting up practice based commissioning and constant communication with the local authority; G.P.s would like to see this as a move forward.
6.10 A member asked if there have been cases where managers have been paid redundancy by Southwark NHS and then been reappointed by the BSU. The managing director responded that while there had been internal challenges about appointments, this had not happened here.
6.11 A member asked for the reason behind Southwark’s decision to be a pathfinder. Dr Amr Zeineldine explained that as a first wave you get extra resources, this is the carrot. The stick is that you have to perform and do some real work, however there are toolkits. Also we considered that there was tremendous value in clinical led commissioning. The managing director commented that NHS London give 4 ½ months of extra resources and also it gave Southwark a chance to shape the process from the outset.
6.12 A member asked if clinical commissioning could lead to a more preventative agenda; keeping people well rather than rather than treating ill people. Dr Amr Zeineldine responded that they are looking to get to European levels in prevention, early detection and treatment of cancer.
6.13 A member commented that one of the issues of the old PCTs was the democratic deficit. He asked how the clinical commissioning consortia intend to ensure that you are will be accountable and transparent to the public and locally elected representatives. The managing director responded that meetings will held in public and papers published on the internet. They also have a strong engagement team who are concentrating on bottom up engagement and now 80% of practices have patient groups. Engagement is a priority for the pathfinder, but a good start has been made.
6.14 A question was asked about the size of patient practices; which can vary from 1,000 to 25,000 registered patients. The managing director commented that each practice has one of two patient representatives. Local issues are discussed, however they also want to promote discussion on the wider issues, for example the acute trusts.
6.15 A member asked if Southwark’s monitory advantages in becoming a pathfinder could result in a two tier system. The managing director responded that the extra money was for pathfinders to lead the way, however while you do get extra resources there is an additional responsibility to share your practice as a pilot. Dr Amr Zeineldine emphasized that it was not a political decision to become a pathfinder; but based on a view that it would improve clinical decisions. A member commented that there is a shift in power, and Dr Amr Zeineldine agreed that there is an increase influence; however he saw this as part of a modernization agenda that has been going on for sometime and delivering good outcomes.
6.16 A question was asked about contracting with private providers and conflicts of interest as some members of the consortia will have commercial interests. Clinical commissioning colleagues suggested that the committee review their conflicts of interest policy.
6.17 A member commented that there have been cases where health services have been commissioned from private providers; however this has led to a loss of control to the detriment of patients. For example cleaning contracts have driven down costs but lead to a poor standard of hygiene. The member went on to comment that the consortia will need to draw up robust contracts and many commercial companies have very good lawyers; he asked how will the clinical commissioning team how they will ensue they have the contractual skills.
6.18 Dr Amr Zeineldine commented that the G.Ps are clinical leaders, not bureaucrats. They will be procuring along clinical pathways, that is the principle and they will be avoiding commercial cherry picking. The robustness of the contracting process is for the BSU to ensure. The managing director commented that he and Southwark NHS strategic director of health service had cause to look at the out of hour doctors’ service, due to concerns, but they are pleased with the progress. Their will be no relaxing of the procurement team. The managing director commented that he finds the lawyers of large acute trust are just as robust as commercial organizations. However he reported that we do recognize the need to ensure we have the right expertise, and commented that he was confident in the consortia’s ability to contract with providers. The managing director went on to explain that GPs services are commissioned centrally.
6.19 A member asked about GP training around Drug and Alcohol services. Dr Amr Zeineldine commented that Southwark is a Beacon service. He said he did not think the picture was as bleak as it had been a few months back. The challenge we have is to look at incentives to encourage G.Ps to take up the training as they frequently have little time in the day.
6.20 The chair set out his intention to undertake a review of clinical commissioning and thanked the team for their presentation.
RESOLVED
The chair proposed a review of Clinical Commissioning including:
The commissioning consortia’s ‘conflicts of interest’ policy will be considered
A short report on the impact of recent NHS savings on patient services will be requested.