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How NHS commissioning for Wiltshire will be organised from April 1

The constitution of the GP-led NHS Wiltshire Clinical Commissioning Group (CCG) will not be published until the CCG is officially authorised to take over from NHS Wiltshire (the Primary Care Trust or PCT) on April 1.  

However, Marlborough News Online has seen a draft of this constitution dated October 2012 – a few weeks before it had to be submitted to the NHS Commissioning Board as part of the CCG’s authorisation process.  It is understood that this draft was only tweaked before final submission.

The constitution shows how the three ‘semi-autonomous’ Groups into which the CCG has divided itself will be organised. The Groups are Sarum (the south of the county); WWYKD (pronounced ‘wicked’ – standing for West Wiltshire, Yatton Keynell and Devizes); and NEW (for north and east Wiltshire) – which includes the Marlborough area.

Below these groups on the organisational table is another tier - the ‘localities’. Sarum is divided into three, WWYKD into four and NEW into two localities.

Each Group has a director who is not a GP. These three jobs were advertised at salaries of £77,079-£97,478.  The directors will lead their group but will also be ‘spearheading one of the county-wide commissioning priorities’– such as urgent care or mental health.

In some respects this organisation reflects the original scheme for three separate CCGs to cover Wiltshire – a scheme the GPs were persuaded to abandon on the grounds that for efficiency and economies of scale the county needed a single CCG.

The running costs for the CCG will partly accrue from the need to replace GPs when they are called to meetings – and there will be plenty of meetings.  The CCG has its Board which will meet in public (as does the PCT) and four committees.  

The NEW Group will have a GP Forum which will meet once a year (with all GPs and practice managers attending), a NEW Group Executive Committee which will meet monthly, and its Locality Groups are expected to meet every two months.

Meetings of NEW’s Group Executive Committee will include the group chair and deputy chair, at least four other GPs, at least two practice managers, the group director, the group Service Development Support Manager, one of the CCG’s non-executive directors (or lay representatives) and a secretary.

The Sarum Group will have at least two Group meetings a year. The Group Board will meet monthly. The Group Executive will meet weekly. The Sarum Health Forum will meet monthly (except for August and December.)  Sarum locality meetings will be monthly (except for August and December) and there is a Sarum Clinical Cabinet which will meet to guide ad hoc projects.

WWYKD’s meetings schedule will have a bi-monthly GP Forum, a monthly Group Executive Committee and its four locality groups will meet every three months.

The coalition’s NHS White Paper of July 2010 (which outlined the restructuring eventually passed into law as the controversial Health and Social Care Act), stated that this major restructuring aimed at ‘radically simplifying the architecture of the health care system’.  In doing so it promised to reduce NHS management costs by more than forty-five per cent over four years and asserted the aim of ‘strengthening democratic legitimacy’.

At present only the CCG’s Governing Body (equivalent to the PCT’s board) will hold meetings which the public can attend.  But it is not stated in the draft constitution how often those will be held. Decisions about commissioning some of the health services for our area will, it appears, be taken at private meetings.

The CCG, which is based in the same Devizes building (left) as the PCT, will be subject to the Freedom of Information Act.  It is doubtful whether Wiltshire’s CCG Groups and Localities will be.

Government supporters painted the restructuring as removing the PCT ‘layer of administration’.  They did not appear to realise that most of the work the PCT ‘layer’ did would need to be replicated by the CCGs.  It is now clear that several ‘layers’ have been put back into the NHS architecture for Wiltshire.  

The size of the CCG’s workforce is not yet finalised.  But as the CCG will have a considerably smaller budget than the PCT, will have fewer commissioning responsibilities and no assets or buildings to manage, it will be smaller.

At least sixty-seven staff members from the PCT will be working for the CCG from April 1.  But for some of its work and office functions the CCG will also be using the services of other CCGs and the newly established Central Southern Commissioning Support Unit which will be based in Newbury.

It is clear that this constitution is not the last word on the organisation.  Although it says that the CCG must ensure ‘patients and the public are fully consulted and involved in every aspect of the commissioning cycle’, it does not say how this will happen.  Indeed it makes a point of saying ‘further guidance is awaited with regard to process for wider public involvement once the CCG is fully established.’

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