Wiltshire's new Primary Care Networks cost half-a-million pounds in consultants' feesAs we have reported, Wiltshire's GPs have been organised into Primary Care Networks (PCNs) which aim to provide more services more quickly, provide surgeries with a wider range of health and care professionals and help keep local surgeries afloat by taking some of the load off the GPs themselves.
The Marlborough area PCN is called the East Kennet Primary Care Network. It takes in GP surgeries in Marlborough, Pewsey, Great Bedwyn, Ramsbury and Burbage.
Wiltshire's primary care system of local surgeries is the responsibility of the Wiltshire Clinical Commissioning Group (CCG). A marlborough.news Freedom of Information request to the CCG has revealed that they have budgeted to spend £500,000 on consultants to help establish the eleven Primary Care Networks across the county.
In November last year, in the private session of the CCG's board meeting, it was agreed to spend £250,000 in each of two financial years - 2018-2019 and 2019-2020 - on consultants to undertake an audit of the county's primary care, see how best to divide the county up into networks and train GPs and their staff.
The consultants would be building on work already done by the Wiltshire GP Alliance to increase access for patients and on the community health care teams many of which a based at GP surgeries.
Beyond the audit, the scope of the consultants' work would be broad - including 'new ways of working', workforce issues and workforce 'redesign', back-office efficiencies, technology solutions and 'building capability' - which, among other things, means 'developing skills' and 'training'.
The document agreed at the CCG's November 2018 Board Meeting listed seven areas of experience and expertise that the successful consultancy firm would show. Some of these were obvious - experience in the NHS and in primary care and so on.
But the final requirement was more specific. The successful firm would have to show the CCG evidence of their "Industry-leading knowledge and insights into healthcare best practice both nationally and internationally." That narrowed the field a bit.
The chosen consultants were McKinsey & Company, the American management consulting firm which works right around the globe.
McKinsey has a long history of NHS work. To name just two of their NHS contracts, in a 2009 report McKinsey called for the NHS to make between £13billion and £20billion savings by 2014. And they were paid by the coalition government for advice on the Lansley reorganisation of the NHS.
The consultancy work on Wiltshire's PCNs was in two phases. First they were to work with three pilot PCNs. From April 2019, phase two would see three months of 'ongoing support' and a review at the end of June.
The document adds: "Further work may be required beyond this and we would welcome thoughts from suppliers on how they could support this work beyond June 2019." McKinsey's work has been continuing with workshops and one-on-one training - so their final bill may be more than was budgeted.
Why was this expenditure needed? Wiltshire has almost double the number of GP surgeries than either the Bath and North East Somerset or Swindon CCGs (with whom Wiltshire CCG is merging.) The CCG simply did not have the staff to meet the schedule.
Of equal importance was the timetable for the introduction of PCNs imposed by NHS England. It was said to be 'ridiculously' tight - with the deadline set at 1 July 2019 for the PCNs to be up and running. There was no mention in the paper before the CCG's board of extra funding to help meet that deadline.
The board meeting was on 27 November 2018 and the chosen consultants could not start work before midway through December 2018. This means the successful company earned £250,000 for little over three months' work. The second, 2019-2020 tranche of £250,000 was - as we have seen - for their work in the three month period April-June 2019.
However, this consultancy contract was not the only one the CCG was paying for in 2018-2019. Their total bill for 'consultancy services' in their annual report stood at £584,000.
That is not much set against their 2018-2019 bottom line total expenditure of £675,546,000. But the £500,000 consultancy for the new PCNs could pay for a dozen or so much needed frontline staff.