Four weeks to go until Wiltshire gets its new NHS commissioning regime

Written by Tony Millett.

Fragmented NHSFragmented NHSThe transition process set in train by the coalition government’s Health and Social Care Act has entered its final month.  From April 1 NHS Wiltshire (the Primary Care Trust or PCT) which has commissioned NHS services for the past six years, will give way to the GP-led Clinical Commissioning Group or Wiltshire CCG.

This transition has involved an amazingly complex programme of handovers as the PCT’s staff, contracts, buildings and desk-top computers are divided up among a number of new bodies.  It’s also involved a good amount of lawyers’ hours.

At the PCT’s penultimate board meeting (February 27), the Trust’s Chairman, Tony Barron congratulated the staff for their hard work – especially has many of them have already started new jobs and are having to do up to three jobs at the same time.

One of the key concerns has always been the future of the staff employed by the PCT.  On 1 April 2011, before the provision of community care was contracted out to Great Western Hospital, the commissioning staff at the PCT numbered 241.  By 31 August 2012 the commissioning staff head count had fallen to 200.

Of those seventy will be employed by the CCG from 1 April 2013.  As of Wednesday (February 27) just six NHS Wiltshire employees had not found new jobs elsewhere in the NHS or left to take up other jobs.  The Board congratulated the PCT’s HR team for handling this part of the transition so successfully.

The situation across the NHS in the whole of the south of England is not so good.  As of Tuesday (February 26) six hundred employees of PCTs and Strategic Health Authorities had still not found other employment.  If this number remains the same on 31 March, there will be a redundancy bill of many million pounds.

Wiltshire PCT has worked closely with the shadow CCG and Tony Barron praised the CCG’s ‘exciting plans’ to change care and treatment pathways: “I am optimistic that it will work.”

It has not all been easy and peaceful.  Members of the CCG were cross that the PCT had extended the contract for Wiltshire’s GP Out of Hours Service.  Wiltshire Medical Services (WMS) signed a contract with the PCT in November 2009 for a five year period with a first option to extend for a further three years.

The PCT took this option up and the contract was renewed to 2018. WMS has a primary care facility at Savernake Hospital with a fully equipped doctor’s response car based there during daytime.

One of the CCG’s lead GPs said they had been working on plans which interlinked with the provision of the Out of Hours Service: “The contract extension had detrimentally affected these plans impeding future service commissioning for the CCG.”

In the wider picture the plans of CCGs across England have been thrown into some disarray by the government’s publication of regulations under the Health and Social Care Act that mandate commissioners to put almost all services out to competitive tender.

At the PCT board meeting Christine Reid, one of the CCG’s non-executive directors, raised the difficulty the CCG will face in dealing with the proliferation of organisations supplying services.  Oversight of contracts needs transparency: “We will have difficulties with all these private companies.”

The organisation representing GPs active in CCGs says that these regulations will involve the commissioning groups in large and unexpected costs of tendering and leave them open to legal challenge by providers which they will not have the staff or funds to cope with.

Dr Michael Dixon, interim president of the NHS Clinical Commissioners, told the GPs’ journal PULSE that some GPs ‘will walk’ if the regulations are not withdrawn: “Unless the commissioner is king, the system is going to fall down. And worse still, the clinicians will walk and feel the whole thing has been a complete waste of time.”

The regulations go before the House of Lords early next month.  Pressure is building on the government to withdraw the regulations, but in the end it may come down to whether Lib Dem peers will back them.