Risks are very red for Wiltshire’s new clinical commissioning GPs

Written by Tony Millett.

The troubles facing the NHS have been hitting the headlines recently – mainly concerning the overloading of hospital emergency services and the political ding-dong about who is to blame.  However, this may be a distraction from some of the real and wider dangers facing the new commissioning system introduced by the coalition government.

The chair of the Royal College of General Practitioners, Dr Clare Gerada, has warned that such are the pressures on GPs' surgeries that doctors may have to give up their roles on the new Clinical Commissioning Groups (CCG) to concentrate on their day job – looking after patients.

Already some doctors have decided to pull-out of their duties with some of the 121 Clinical Commissioning Groups in England.

When the board of Wiltshire CCG, which took over from the Primary Care Trust on April 1, meets on Tuesday (May 28) it will be presented with a very red looking 'High Level Risk Register'.

Top of the list is the NHS 111 non-emergency telephone advice service which has been having serious problems during its ‘soft launch’ period.  No date has yet been set for its full live launch.

The contract for the Wiltshire 111 service was signed with the private provider Harmoni in July 2012.  The CCG has had to put in extra support to maintain patient safety and taken a QC’s advice on whether Harmoni are in breach of the contract.  

In the light of problems over the contract the CCG has also appointed an Associate Director of Commissioning to increase its resilience when it contracts services.  No date has yet been announced for this service to launch fully.

Second on the risk register’s red list is the request for a £4.5million grant to cover capital equipment purchased for Wiltshire’s community services. If NHS England will not fund this, the money will have to come from the CCG’s own budget – eating into its ‘headroom fund’.

Next come worries about requirements by the Care Quality Commission (CQC) to provide care for the under-sixteens under the Mental Health Act.  The CQC also appears in the risk the CCG faces over the Commission’s adverse inspection of the Royal United Hospital in Bath and the quality of care that may become available there.

Next on the red list, the CCG has highlighted the dangers posed if its own staff do not ‘respond positively’ to its plans for the year.  Added to that there is the continued financial drain of the delayed transfer of care for patients who are ready to leave hospital – what some newspapers still refer to as ‘bed blockers’.

On the financial side, the CCG has a red warning about its budget: “There is a risk of resources being removed from the CCG to fund National Commissioning Board [now called NHS England] cost pressures which will impact on the financial position of the CCG.”

The final red line in the ‘High Level Risk Register’ concerns mental health services.  There is a risk that when ‘payment by results’ is brought in to this area of the NHS, mental health care may “become unaffordable”.  There is also the uncertainty of the Avon and Wiltshire Partnerships ability to deliver the contracted service after Bristol puts its mental health care out to tender.

This register ends with one ‘amber’ risk concerning the CCG’s back-office support: “The CCG has contracted with Central Southern Clinical Support Unit (CSU) and is dependent on the support that the CSU will provide.  The CSU is also a fledgling organisation and has gaps in capacity/process that will affect the operation of the CSU.”

That ‘also’ carries some weight: the CCG is a fledgling organisation and the amount of red ink on its High Level Risk Register will worry those in the various layers above it.

For previous Marlborough News Online reports about the NHS 111 service put NHS 111 into our search feature.