News dot2left cropped500pxt
  • 4MI-2013-11-28 030
  • Sunset2
  • TdB-Pewsey 044
  • D4S9273
  • Bluebells-in-West-Woods-10-05-09------30
  • IMG 8472-2
  • IMG 9097-2
  • ARK Manton -2012-01-14 49-
  • Christmas-Lights 15-11-20 097
  • MYFC 005
  • Landscape
  • Hares 017cropped
  • Duke-of-Kent 086
  • Torch-2012-05-23 093-
  • D4S0472
  • Mop-Fair---10-10-09------08
  • Camilla-2012-10-19 152
  • Xmas-Lights-2011-11-24 10
  • Town-Hall-2011-05-03 08-2
  • Marlborough-2013-04-18 St Peters-2
  • Civic Selfie1
  • Big-Bull
  • D812668
  • Silbury-Sunset---10-06-08-----07-2
  • Jazz Fest Sat 572


This email address is being protected from spambots. You need JavaScript enabled to view it.

Health & NHS

Update: medical records & - admission that patients ‘may lose trust’ in NHS

Our original report on '' can still be read below this new report.

NHS England, who are running the scheme to share medical records with third parties, have issued a worrying risk assessment of their scheme.

It says that using medical records without patients’ consent may lead to them losing trust in the confidentiality of the NHS.  

The assessment says the scheme runs the risk of degrading patient trust in the NHS, putting information at risk of hackers and identifies ‘a small residual risk’ that patients will be identified.

A frame from the NHS England video: is privacy just like a jigsaw?A frame from the NHS England video: is privacy just like a jigsaw?But it states baldly that the projected benefits of the scheme (see our earlier story below) outweigh the risks to patient privacy.  One of the identified benefits is providing a boost to economic growth.

A GP who lives in the north of England where the leaflets have already been delivered, wrote to the GP’s magazine PULSE that she had not been told how patients should opt out.  She added that some GPs were telling their patients to opt out of the ‘summary record scheme’ which is not at all the same as

Pulse had previously reported a poll of GPs indicating that 40 per cent of England’s GPs would be opting out of as regards their own medical records.

This GP pointed out that as information already given by patients was provided in strict confidence and good faith that it would never be shared, the default position ought to be that patients opt in to the scheme rather than having the responsibility to opt out.

She also says that the NHS’ own mandatory training on Information Governance states that consent must be sought each time information from medical records is proposed to be shared.  “How”, she asks, “can automatic sharing of these past records without actively seeking current verbal or written consent be legal under the data protection act?”

The basic problem is that at law medical records remain the property of the Secretary of State for Health – the man whose overall responsibility for the NHS was removed by the coalition government’s Health and Social Care Act.

The opt out form can be found here.

Go to this site to see the leaflet.

And to this site to read the full risk assessment text from NHS England.

There is a short animated video promoting on this page.


Before the end of the month we will all be getting a leaflet through the door about the government’s plans for our medical records.

The leaflet is titled “Better information means better care” and will explain how, from March, our medical records will be extracted from GP surgeries and passed to a new body called the Health and Social Care Information centre (HSCIC) so they can be placed on the ‘’ database.

The idea is to allow medical records to be shared with other parts of the NHS, researchers and private pharmaceutical companies.  And the aim is to improve and hasten research that will lead to advances in medicines and treatments.

The information will be ‘anonymised’ – it will not include your name but will still carry your NHS number, date of birth, post code, gender and ethnicity.  And as people in rural post codes know it is very easy to identify who’s who among a small number of homes.

It has also been admitted that there is a small risk that some patients could be identified by insurers and commercial health providers who could match their own data against the anonymised records.

If they have got permission to use the records and you are a client, they could match the anonymised information with their own data.   They will have your date of birth and post code and could make a match with the same categories of information on medical records.

Then they could see whether you had a drink problem or a long-term illness or even if you had told your doctor a certain condition was prevalent in your family.

The scheme is backed by many medical charities who say they need it to speed up their research.  And it is opposed by some who see it as a breach of principle about keeping private our most private data.

Any organisation or researchers can apply to the HSCIC for data and each application will be considered individually. 

The HSCIC will charge a fee to cover its costs, but there is no control at all over the potential profits that can be made from the data.

The government’s original idea was to make the scheme compulsory.  But you will be able to opt out of it.  

However the leaflet will not contain an opt-out form.  To opt out you have to go to your GP. And there has been criticism that information about this route for opting out is pretty well hidden away.

When asked in the House of Commons whether the Department of Health had an estimate of the number of hours GPs will spend talking to patients about, the minister, Dr Dan Poulter, Parliamentary Under Secretary of State in the Department of Health, had no clear answer.  But there is, he said, “a patient information line which patients can call if they have questions, which will ease the burden on GP practices.”

There is a possibility that the scheme will prove to be breach of new EU privacy rules.

The costs of this scheme have not been finalised.  But the leaflet distribution will cost NHS England £1.2 million.

Print Email

Take a ride around Maggie Bell’s patch to see how healthcare is changing in Wiltshire

Maggie Bell at Ramsbury SurgeryMaggie Bell at Ramsbury SurgeryFor evidence that healthcare in Wiltshire is changing all you need is an introduction to Maggie Bell.  She’s one of the Wiltshire Clinical Commissioning Group’s (CCG) new Care Coordinators – there are 29 working across the county at a cost of £1.3 million a year.

She was the first to start work.  Since September she’s been based at Ramsbury Surgery and has responsibility for patients registered with the GPs’ surgeries at Ramsbury, Marlborough and Great Bedwyn.

She reports to a manager at Ramsbury surgery and to the leader of the community nursing team based at Savernake Hospital. She is employed by GWH and paid by them with funding from the CCG.

She has a list of 22 people she visits: “But it’s growing all the time.”  If there’s an obvious medical problem she will visit with the community matron from Savernake Hospital: “If someone has a social need but they also have a medical need, it’s better we both go on a single visit – people don’t like lots of people coming into their home.”

The CCG’s flagship policy is its Community Transformation plan which aims to bring health care closer to people’s homes, keep them out of hospital for longer and make sure they are safe when they leave hospital.  It is aimed particularly at the elderly, most vulnerable patients.

Maggie Bell is not a nurse.  Her training and experience has been in social care.  And her role is preventative – to keep people healthy and help them avoid issues like isolation and stress that can lead to illness especially in the elderly.

One of her many jobs is to monitor people once they have left hospital.  She has access to the GWH data base that tells her who has been discharged and she will then contact or visit those who are likely to be at risk to make sure they are doing well.

This is a sure way to prevent the all too frequent occurrence of quick re-admissions to hospital – especially of the elderly.
“The GPs love it – to be honest they think it’s an absolutely brilliant scheme.”

The now defunct Wiltshire Primary Care Trust established the county’s ground-breaking neighbourhood teams of nurses and physios. When the PCT was no longer allowed to provide services, the teams were transferred under contract to Great Western Hospital and will be run by them until April 2016.

In their Community Transformation Plan the CCG are taking the neighbourhood team idea to a whole new level – and are working closely with Wiltshire Council to develop this new way of working at community level. Across the county, they’re designing local care for 23 clusters each of about 20,000 people.

In this they are ahead of the field:  the government has ordered that from April 2015 a slice off the CCGs’ funding will go towards a £3.8 billion pooled budget for CCGs and councils to join up health and social care services in England – the much-talked about ‘integration’ of care.

This fund was called the Integration Transformation Fund – a descriptive title.  But the politicians have got at it and it is now called the Better Care Fund – an aspirational title.

Maggie Bell and her fellow care coordinators are the first part of the CCG’s Community Transformation Plan.  Among other initiatives still to come is a ‘rapid response’ service that will bring health and social care within one hour to support people in time of crisis and prevent ‘unnecessary’ hospital admissions.

Maggie worked for two years as team leader for the Marlborough area’s Leonard Cheshire Disability’s Help to Live at Home team – a Wiltshire Council scheme. Now she really feels she’s making a difference: “I have the added advantage of knowing the area, the social services and community health team.”

“I’m stopping people being unhappy – to be frank. It helps people keep healthy when they know someone cares – especially people who come out of hospital. It’s good for them to know someone’s there.”

Margaret RendleMargaret RendleMaggie took me with her to visit Margaret Rendle who’s over 80 and lives in Marlborough. He husband died very recently and suddenly. Her GP asked Maggie to see her because she was afraid Margaret was very isolated, had all the problems of coping with the bereavement and needed to get out of her house more.

And frankly, Margaret’s not at all happy.  She’s still in shock and not feeling too good in herself.

Maggie filling in that formMaggie filling in that formShe’s got bad arthritis in her hands, so Maggie fills in the huge Council form – “It’s as big as a book” – to get her council tax changed.  And Maggie takes a look at the carers’ log to make sure they’re coming as they should.

Margaret is desperate to keep out of hospital – worried what would happen to her partially disabled son.

Maggie Bell is going to phone her bank to ask about her husband’s will. She’s going to talk to her GP as Margaret wants to know why her husband died in hospital so suddenly.

And there’s a large bill for the carers her husband needed that’s making Margaret anxious and must be sorted out. Margaret is very relieved and grateful that Maggie is on her case.

Maggie & her essential carMaggie & her essential carAlthough they are such a new addition to the NHS’ armoury, the Care Coordinators are settling in well and getting on with their important job.  As Maggie puts it: “Things are going very well with all the coordinators – the commissioners are very pleased – like the GPs.”

Every month all the 29 Care Coordinators meet together for a forum – exchanging information about support charities and care agencies and go through a case study to see how they can do things even better.  And they probably moan a little about the mileage allowance!

They do a great deal of driving – especially in the most rural areas like Maggie’s.  Quite who picks up the carbon footprint for all that driving must remain another mystery of the complex restructuring of the NHS.

As other parts of the Community Transformation scheme come on line, the Care Coordinators jobs will change as they have more local elements to fit in with.   The aim is that by the end of 2015 the CCG’s new community system will be looking after many more of the vulnerable – who are most often the elderly – in their homes and keeping them out of hospital.

Care Coordinators are a first step in the plan. And Maggie's enthusiastic about what they can do: "I love my job."

[With thanks to Margaret Rendle and Maggie Bell.]


Print Email

NHS’s winter pressures: will GWH get some of the government’s new winter money?

In an exclusive story, the Health Service Journal (HSJ) says the government has found another £150 million to help ease this winter’s pressures on hospitals.

It is now clear the government is petrified that the NHS may face unsustainable pressures in the coming months – especially in already over-busy A&E departments.

The HSJ says this new money will be announced within days.  It will be on top of the £250 million already allocated and will go to help hospital trusts which, like the Great Western Hospitals Foundation Trust (GWH), got nothing from the original £250 million fund.

GWH applied with the Swindon Clinical Commissioning Group (CCG) for a share of the first £250 million. That money went to 53 CCG’s to support their local acute hospitals – the average amount was £4,170,000.

The money was allotted to trusts that had not coped well last winter or that are considered to be in such financial straits that they would not cope this winter. Some said the money was a reward for failure.

GWH got none of that £250 million and has been putting into place its winter planning using its own funds and financial assistance from CCGs.

During last winter GWH saw a ten per cent increase in people coming into its A&E department as well as a 6.7 per cent rise in emergency admissions.  This winter’s pressures are already being felt at GWH’s A&E department.

GWH’s bid for extra funding included extra spending on community health services, on end of life care, increased staffing in A&E and support for the timely discharge of patients.

As MNO has reported GWH have already recruited more nurses and midwives and a full re-design of their A&E department will be completed before Christmas.

Working with Wiltshire and Swindon CCGs, GWH have already put in place a number of steps to alleviate this winter’s pressures on staff and facilities.

They have invested £3.2 million in extra medical beds and doctors. And have employed three extra emergency medicine consultants – bringing the total up to nine consultants. And they continue to recruit more nurses.

Wiltshire’s community health services – run by GWH – now have Care Coordinators in each locality to help patients live well at home for longer and reduce unnecessary and unwelcome stays in hospital.

GWH have also launched an incentive scheme for nursing staff, midwives and health professionals like physios.  This will enable staff to earn extra pay for working extra shifts – reducing the use of agency staff who may not be familiar with the hospital or with patients.

A GWH spokesman explained: “Paying staff in this way is better value for money for the taxpayer as it’s more cost effective than using agency staff.  Our staff work incredibly hard 24/7, 365 days a year, often in challenging circumstances and this is an extra thank you to those who are willing to help out at our busiest times.”

It’s not just the number of people arriving at the front door services like A&E that cause problems.  It’s also pressures at hospitals’ back doors: patients who cannot be allowed leave hospital wards once their treatment is complete because they have nowhere appropriate to go.

These are called ‘Delayed Transfers of Care’ or DTOCs and they cost CCGs a great deal of money.  They used to be called ‘bed blockers’ - as though it was the patient’s fault.

Reducing the time patients wait to leave hospital involves close coordination with local authorities’ social care services who have to ensure patients – often the frail and elderly – go to an appropriate nursing home or rehab ward or can be cared for safely in their own home.

Oxfordshire CCG, which has had one of the worst DTOCs record in the country, has allotted more than a fifth of its £10 million extra winter funding to Oxfordshire Council to help reduce its costly level of DTOCs.

It is worth noting that Oxfordshire CCG identified 23 temporary schemes to alleviate winter pressures at their hospitals.  Some of these are to last six months.

Oxfordshire CCG aims to recruit skilled staff to fill more than 50 new full-time roles to work over the winter period – as well as an unspecified number of other extra nursing staff.  Whether they will be able to recruit this number in time and within budget will doubtless feature on their risk register.

But the scale and cost of winter measures in Oxfordshire, underlines the seriousness with which the NHS is facing the approaching cold weather.

GWH’s A&E or as they call it ED for Emergency Department:  Some days ago we published a story headlined “Twelve patients a day had to wait on A&E trolleys in great western hospital probe reveals.”  

This was a report of story first published in the Daily Mail.  MNO understands that GWH’s Freedom of Information response stated that “up to twelve patients” in a day had been waiting on trolleys in a corridor. 

This, by some sleight of hand, was changed in the published story to read “12 patients a day have to wait on trolleys in corridors in A&E” – clearly implying it happened every day.  

Having looked back at the wording of their FOI response, GWH have now issued another statement:

“The number of patients treated in ED can change greatly from one day to the next. We have never shut our doors and always do everything we can to treat and care for our patients using the space and resources we have at the time.”

“There are occasions when we have been extremely busy, this means we have asked patients to wait on a temporary trolley until a suitable bed is available. Any patient waiting on a trolley will have been assessed and will have a dedicated nurse caring for them and observing them until they are moved to a ward.”

Print Email

Physio practice brings Hollywood-style foot treatment to Marlborough

Podiatrist Emma Ansell giving Karen Shields a Med-pedPodiatrist Emma Ansell giving Karen Shields a Med-pedA Marlborough physiotherapy practice is offering an exclusive Hollywood-style treatment for something that is walked all over every day – feet.

Clients from as far away as Bath and Gloucestershire are already coming to the Hughenden Yard practice for this new exclusive treatment, which has previously only been available in London.

Podiatrists – the new name for chiropodists – and salons usually concentrate on one thing: either foot health or foot beauty.

Now, James Hatt & Associates has combined both approaches in its new glamorous med-ped treatment.

The Medical Pedicure is given by a highly trained and qualified podiatrist. It involves a comprehensive health check and treatment of the feet followed by a pedicure.

But this goes even further than feet feeling and looking great. Many musculoskeletal problems, such as with knee joints and backs, can be caused by feet, and the early warning signs of some illnesses - such as the increasingly common diabetes and the number one cause of death, blocked arteries - can be spotted through foot examinations.

“Feet are important to health, so we thought: why not make it a luxurious experience? We want to encourage younger women in particular to have their feet pampered and their health checked at the same time,” said practice director, Amanda Hatt.

“We also didn't want to send clients away to a salon for the finishing touches of a pedicure, and perhaps not having such a good service as they would with our podiatrist.”

Karen Shields receiving her Med-ped from Emma AnsellKaren Shields receiving her Med-ped from Emma AnsellIn the hour long appointment, the med-ped offers a diabetic, neurological and vascular screening; a foot bath, foot scrub and foot mask; gets rid of the dreaded cracked heels in one treatment – with, unlike salons, the added hygiene security of medically sterile equipment – and nails cut and painted.

And feet are left looking like they belong on a movie star.

To offer this treatment, James Hatt refuses the bread and butter of most podiatrists, the fifteen minute toenail-cutting service.

“We would be doing our clients a disservice with such a short treatment. It's better to offer a proper, rounded consultation.” Amanda adds: “It may not the quickest way to way to grow this new part of the business, but it's the best way for our clients.”

Regular client Karen Shields, from Pewsey, pictured receiving a med-ped from Heath and Care Professions Council registered podiatrist Emma Ansell. “I came in for knee problems, and I've had physio, massage and podiatry.

“This time I've tried the med-ped. I love Emma's approach with a comprehensive overview of the problem. It's a long term solution rather than a quick fix.”

For more information visit or ring 01380 730473.

Reader offer: get a Hollywood-style med-ped treatment with James Hatt Associates. Pay for a podiatry treatment (£45)and upgrade to med-ped (normally £65) free of charge only with the coupon on this week’s Marlborough News Online newsletter. Not currently a newsletter recipient? Sign up for free today!

Print Email

Friends of Savernake Hospital give patients the chance of some fresh air and a chat

Four Ailesbury patients with their health care support workers (in light blue) and l to r Rosemary Pike, Val Compton (Trustee of The Friends of Savernake Hospital), Sister Emma Bazell and Sister Helen Hodges (in dark blue) . Four Ailesbury patients with their health care support workers (in light blue) and l to r Rosemary Pike, Val Compton (Trustee of The Friends of Savernake Hospital), Sister Emma Bazell and Sister Helen Hodges (in dark blue) .

Savernake Hospital’s Ailesbury Ward has a sizeable balcony leading off its day room.  The balcony’s surround was painted battleship grey and its glass panels had a green film from the surrounding trees - not very inviting.

Now with a grant of £2,451 from the Friends of Savernake Hospital, the balcony has been completely refurbished the surrounds have been painted a bright green and the glass has been cleaned.

The ward’s clinical services manager, Rosemary Pike, says she is very thrilled to be able to get patients out into the fresh air and give them a real change of scenery.

The Ailesbury is a medical rehabilitation ward and is part of Great Western Hospitals Foundation Trust.  Ownership of Savernake Hospital was transferred to GWH when Wiltshire’s Primary Care Trust was abolished as part of the government’s restructuring of the NHS.

The ward has 24 beds and takes patients who live in the area and have been having in-patient treatment in one of three local acute hospitals: GWH in Swindon, RUH in the Bath and Salisbury Hospital.

Sometimes patients come to the Ailesbury who have been treated at specialist units as far afield as Oxford or the south coast.

The balcony boasts some new and sturdy chairs and tables, very smart parasols and planters complete with plants. It is sheltered by the row of mature trees along the edge of the cricket field.

GWH is on the look-out for volunteers to help on the Ailebsury Ward.  Volunteers can assist medical and support staff in a number of ways - such as admin tasks, befriending patients or leading patient activities.

The balcony from ground levelThe balcony from ground level

People able to volunteer should contact Carol Orrow, GWH’s voluntary services manager on 01793 605248.

And the Friends of Savernake Hospital also need to find volunteers to help in their hospital shop and with the trolley shop.  Check out their website.

Print Email

Campaigning to save the NHS: Wiltshire’s determined activist is up for the challenge

Christine Gale Christine Gale It was the first demonstration that Christine Gale had ever been on.  On the last Saturday of September when the Tories were assembling in Manchester, she – with her partner Guy – and about 49,998 other activists marched to protest against cuts and in favour of protecting the NHS from the coalition government.

There were several other protestors there from Wiltshire and the Devizes constituency.

Saving the NHS has become Christine’s mission in life.  Disarmingly she says: “I’m just an NHS user.”

She and Guy live in Castle Combe. Both are retired and Guy brings to her campaign a career’s worth of experience in design and typography.

Christine is no ordinary protestor. She has always been a ‘political person’ and a life-long Conservative voter.

Her grandfather was a traditional hardworking Tory who stoked boilers. Her father was a very successful self-made businessman who was a tremendous admirer of Prime Minister Thatcher.

Looking ahead to 2015, she told Marlborough News Online: “I’m going to vote for the party that reinstates the NHS as a public service.”  

She was cheered to hear Labour’s Andy Burnham say at the Manchester rally that they would repeal the Health and Social Care Act that’s the basis of the current £3 billion reorganisation of the NHS.  But before Labour gets her vote she wants to see that promise in their manifesto.

Christine & Guy ready for the Manchester protest marchChristine & Guy ready for the Manchester protest marchShe believes that it is a waste of time campaigning on small, local issues, and that defenders of the NHS should concentrate on campaigning nationally: “What we can do is to say to MPs ‘In the next election we won’t vote for you unless you protect the NHS’.”

By protecting the NHS she means keeping it as a National service rather than a ‘notional’ service; keeping it public and out of the hands of private providers or profiteers; and stopping the Americanisation of the NHS.

Christine finds it ‘really scary’ that the forthcoming trade deal with the USA (watch out for its full name –Transatlantic Trade and Investment Partnership or TTIP) will leave the NHS open to almost mandatory privatisation by big American corporations.

Under this agreement the NHS would never again be able to be the ‘preferred provider’ of health services so campaigners are demanding the NHS is exempted from the TTIP.

She has mixed feelings about doctors and the part doctors have been given in commissioning NHS services: “Doctors should be making people well and efficient and accountable managers should be running everything else.”

Why did Christine take on the role of defender of the NHS?  After her parents had a bad accident, she saw how the private sector could not cope but the NHS gave them ‘fantastic care’.

Later, when two other family members had cancer she saw again the worst of private care  – but also great NHS treatment and some very poor NHS care leading to a case of MRSA and terrible bed sores.  She knew then that the NHS must be protected and improved.

She did not believe the current government’s reorganisation and its firm belief in privatisation was the way to do it.A banner that caught Christine's eye: 'NHS is for people not for profit'A banner that caught Christine's eye: 'NHS is for people not for profit'

“When I started campaigning, I found it very difficult to get people interested enough to run local groups.”  So she took her campaign out and about – and onto the internet.

She and Guy spent two days at the music festival at Little Somerford – going to a music festival was another first for them both. They handed out 1,500 of Christine’s wallet-sized protest cards and she was asked to give several short talks from the platform about the threats to the NHS.

She joined 38 Degrees activists for the Wiltshire petition against privatisation that was delivered to the new Clinical Commissioning Group at its Devizes headquarters in April. And she was appalled when she heard a politician dismiss 38 Degrees as people making vulnerable people anxious.

As someone who missed out on further education, she has surprised herself by making speeches at events. She once introduced herself as a “Wiltshire bumpkin” and had the audience enthralled by her passionate defence of the NHS.

Now she has taken to the internet and become part of the very busy network of campaigners aiming to keep the NHS strong, free and un-privatised. She started with a Yahoo group site but now has a website of her own which carries lots of evidence of what is going on behind the daily headlines.

She is in touch with NHS Action who want to put up NHS candidates in the 2015 general election – though Christine is not quite sure about single issue MPs - and with the KONP (Keep our NHS Public) campaign.

She certainly got fresh impetus for her campaigning from the Manchester march and was especially enthused by the ‘passionate speech’ by the TUC General Secretary, Frances O’Grady.

But she was utterly appalled to find barely any mention in the newspapers or on the BBC of the Manchester demonstration – the biggest the north-west of England has ever seen. “Even in what we call a democracy it seems it’s becoming harder and harder to get heard.”

You can email Christine at This email address is being protected from spambots. You need JavaScript enabled to view it.

Print Email

Wiltshire’s Clinical Commissioning Group is 100 days old – and into the hard work

Last week the National Health Service celebrated its sixty-fifth birthday – a distinctly wobbly anniversary. This week Wiltshire’s GP-led Clinical Commissioning Group (CCG - which replaced the Primary Care Trust - PCT) is a hundred days young.

It is, of course, far too early to attempt a report on the CCG’s progress. As a commentator said recently, changing anything in the NHS is like turning round the proverbial super tanker.

However work is going ahead in Wiltshire CCG with some speed. One advance being rolled out across the county is a programme to speed up dementia diagnosis.  Improvements in the care of those with dementia is a much more complex and wide-reaching problem.

The CCG’s first major headache is the government’s new NHS 111 urgent care ‘phoneline.  The Wiltshire service is in the hands of the commercial company Harmoni under an inherited contract.

The service is still not considered safe enough to go live. In this Wiltshire CCG are not alone. A recent survey by the GPs’ journal PULSE of 440 GPs found that only eight per cent believe the computer based triage system at the call centres is safe for patients.

Coming soon will the expense and organisational risk of the tender process for Wiltshire’s community maternity services.
Looking ahead, the CCG have in the pipeline a new plan for community healthcare to bring services closer to patients:  “The agreed approach is to make all health related local services become based in practices with specialist services clearly supporting the practices.”

Already the CCG’s leaders are working with staff at Great Western Hospitals (who hold the contract for all Wiltshire’s community healthcare) to upgrade the neighbourhood nursing teams To maximise the teams’ impact they are employing care coordinators.

It is not yet clear how far the CCG’s plan will bring medical services into practices.  But at last month’s meeting of the CCG’s governing body, its Finance Director, Simon Truelove, gave a warning that “By taking out small elements” from the work the major hospitals do now, there is a “risk of destabilising our acute hospitals”: “We have to be careful about taking out low level services.”

One achievement the CCG has logged is that all their contracts with service providers for the current year have already been signed.  Not something achieved by this stage of the financial year under the PCT – although the PCT had more and wider commissioning responsibilities.

It is very difficult to judge how far the government’s promise in 2010 to reduce NHS bureaucracy and its costs have been achieved with the introduction of the CCGs.  We know that Wiltshire CCG’s running costs are currently about one third higher than were the PCT’s.

Staffing levels are impossible to compare accurately due to the CCG’s reduced amount of commissioning and their outsourcing of various ‘back office’ elements – including HR and finances – to an independent Commissioning Support Unit. And they have no buildings to maintain.

In June 2011 the PCT employed 240 commissioning staff.  By 31 August 2012 this headcount had fallen to 203.  The CCG employs (as at May 31 this year) 95 people.  But some of those are part time and that total equates to 83.81 whole time equivalent staff.  They are still recruiting.

On top of those staff numbers and costs are the GPs who have to be replaced at their practices when they attend CCG meetings and events.

Under his recent Spending Review for 2015 George Osborne intends to take £3.8 billion from the NHS budget to hand to local authorities to deal with rising social care needs – and costs.  He also plans to cut NHS administration costs by about another tenth.

This has already roused one Midlands CCG chairman to worry in a blog about “Running Costs”:

“The £25 [per head] running cost is already a blunt tool, not taking into account size of organisation or local health needs. The commissioning system has already lost a significant number of experienced staff and is more fragmented.”

“CCGs are already incredibly lean…There’s a point where a lean organisation becomes an ineffective one.”

Some of England’s 211 CCGs have been quick to arrest the decline in investment in primary care by significantly boosting budgets for enhanced local services.

The ‘locality’ or sub-division of Wiltshire CCG which includes the Marlborough area is NEW – for North and East Wiltshire. NEW has announced details of their 2013-2014 budget for these enhancements.

Their aims are quite clear:
“Reduction in urgent admissions to acute hospitals from care homes – reduction in urgent admissions through appropriate primary care interventions – increased delivery of local services i.e. patients managed by GP or outpatient services provided in the primary care environment.”

In addition the agreement will help achieve the NHS savings target – known by the acronym QIPP (a very serious level of savings unfortunately pronounced ‘quip’.)

The money to be divided among NEW’s nineteen practices (with 165,338 patients) through this agreement is £1,192,087.  Of this nearly a fifth (or £248,006) is described as the ’Basic Commissioning Element’.

It covers some of the locality’s organisational costs:
“Each practice to have a named Commissioning lead GP – GP attendance at 70 per cent of regular locality meetings… – Carrying out 100 per cent of audits as agreed at locality meetings… – Create a register of between 0.5 and 1.0 per cent of patients in each practice most at risk of hospital admission…– A representative from each practice to attend their appropriate local area board meeting (or health equivalent) annually – Attend regular GP clinical forums.”

This money, like the rest of this local budget, will be paid quarterly “on the production and review of the appropriate evidence” to satisfy the CCG’s executive that the tasks have been completed. Quite an administrative job in itself.

During the on-off progress of the government’s Health and Social Care Bill, it was claimed locally that savings made by the future CCG on the £25 per head running costs budget would go towards front line services. It is now clear that, over and above the £25 per head set by the government, some of what are essentially  running costs for the ‘locality’ are shown as coming  from ‘front line’ budgets.

Print Email

More Articles ...

  • Mop-Fair---10-10-09------08
  • Camilla-2012-10-19 152
  • IMG 8472-2
  • Christmas-Lights 15-11-20 097
  • Bluebells-in-West-Woods-10-05-09------30
  • TdB-Pewsey 044
  • Civic Selfie1
  • Hares 017cropped
  • Marlborough-2013-04-18 St Peters-2
  • D4S0472
  • Big-Bull
  • Landscape
  • Xmas-Lights-2011-11-24 10
  • 4MI-2013-11-28 030
  • D812668
  • Torch-2012-05-23 093-
  • MYFC 005
  • Duke-of-Kent 086
  • Jazz Fest Sat 572
  • ARK Manton -2012-01-14 49-
  • D4S9273
  • IMG 9097-2
  • Silbury-Sunset---10-06-08-----07-2
  • Town-Hall-2011-05-03 08-2
  • Sunset2