Agenda item

Report of Dr Sarah Raistrick, Chair, Coventry and Rugby Clinical Commissioning Group (CCG) who has been invited to the meeting for the consideration of this item

The Scrutiny Board considered a report of Dr Sarah Raistrick, Coventry and Rugby Clinical Commissioning Group (CCG) which provided an update on the implementation of the NHS Long Term Plan in relation to the commissioning function of the CCG within Coventry and Warwickshire. Dr Raistrick attended the meeting for the consideration of this item along with Andrea Green, Chief Accountable Officer.

The report indicated that The NHS Long Term Plan, published in January 2019 set out how the NHS would move to a new service model in which patients would get more options, better support and properly joined up care at the right time in the optimal care setting. It set out:

·  How the NHS would strengthen its contribution to prevention and health inequalities

·  The NHS’s priorities for care quality and outcomes improvement for the decade ahead

·  How current workforce pressures would be tackled and staff supported

·  A wide-ranging programme to upgrade technology and digitally enabled care across the NHS

·  How to return the NHS onto a sustainable financial path.

The Plan stated that local NHS organisations would increasingly focus on population health, moving everywhere to Integrated Care Systems (ICSs) each covering a population of c1m by April 2021 growing out of the current network of Sustainability and Transformation Partnerships. These would have a key role in working with Local Authorities at ‘place’ level and through them commissioners would make shared decisions with providers on how to use resources, design services and improve population health. 

Every ICS would need streamlined commissioning arrangements to enable a single set of commissioning decisions at system level. This would typically involve a single CCG for each ICS area. CCGs would become leaner, more strategic organisations that supported providers to partner with local government and other community organisations on population health, service redesign and LTP implementation. 

The Board were informed that Coventry and Warwickshire were on a journey towards becoming an ICS by 2021. The CCGs had set out to determine their response to achieving ‘streamlined commissioning’ with a 20% administration cost reduction during 2020. The governing bodies had asked for a transitional case for change to be developed. Initial consultation including briefings and engagement events for staff, GP members and governing body members had been held since December 2018. Other events were held with key stakeholders between March and May, 2019. The purpose of this activity had been to bring together a wide range of stakeholder views from across the locality.

The CCG had considered the transitional case for change at their meeting in May. In their discussions they were clear that, with the development of a single strategic commissioner, about 80% of the current CCG work would be aligned with ‘place’. (4 places – Coventry, Warwickshire North, South Warwickshire and Rugby). 20% of the current CCG activity would align with commissioning at a Coventry and Warwickshire level. The governing body made a recommendation to GP members that the strategic direction would be a merger of the three local CCGs subject to the development of a full case for change.

Following an additional briefing, GP members voted for the CCG to explore two options: firstly, a single management team working for each of the three CCGs and secondly, a merger of the three CCGs with a single management team. The Board noted that a considerable amount of work would now be required with colleagues and stakeholders across the system throughout the process of development.    

Members raised a number of issues in response to the report and responses were provided, matters raised included:

·  Further information about other CCG’s financial deficits and, in the light of these, the impact for Coventry of the potential merger

·  The areas where savings would be targeted

·  The optimum size of the model which allows for efficient working

·  Did all GP practices in the city engage in networking arrangements

·  What would happen if one CCG was against the merger

·  Details about the university GP practices

·  A suggestion that consideration be given to a regional health commissioning system which could result in increased financial savings

·  Details of the required 20% savings

RESOLVED that:

(1) Report received for information and assurance and the requirements for engagement of stakeholders during the development phase be noted.

(2) A copy of the GP cluster map be sent to Board members.

(3) The Chair, Councillor Clifford, on behalf of the Board, to write to WMCA Mayor Andy Street requesting that, in light of all the potential financial savings, consideration be given to having a regional health commissioning system which would still allow the opportunity for localism, resulting in more financial resource being available for front line health services.