Reorganisation and winter: is our area's NHS facing a perfect storm?There was no ceremony, no cake, no fizz - the governing board of the Wiltshire Clinical Commissioning Group (CCG) met in public on Tuesday (November 26) for the last time as a single independent organisation - established by law under the Coalition/Lansley Health and Social Care Act (2012).
The meeting got off to a lower than low-key start when one of the long-serving lay members reflected on the board's pre-meeting: "An air of gloom has descended on the place."
Against the backdrop of discussions about the A&E figures at two of the three hospitals that serve Wiltshire (very poor) and preparations for winter (very solid - but you cannot prepare for everything), the seven year-old Wiltshire CCG was slipping quietly and a bit reluctantly into history.
By 1 April 2020 it will have merged completely with the CCGs for Bath & North East Somerset and for Swindon.
What was designed - very expensively - as a locally based system, will lose much of its local emphasis. The CCG divided Wiltshire into three smaller localities (Sarum, North & East and West). Now Wiltshire is becoming one locality in the much larger CCG - known as BSW (for Banes, Swindon & Wiltshire).
Patients (never mind journalists) wanting to question the new BSW CCG at their board meetings, will have to go chasing round different sites across the new CCG's three local authority areas - where meetings are currently being held during the new BSW CCG's shadow months. No one yet knows for sure where the new BSW CCG will have its headquarters.
At the more local level there will be the new Primary Care Networks of GP practices. But these have no legislative basis and will not be have regular meetings in public. Indeed it is not clear how they are going to communicate and engage with the public.
The complexities as these changes take place are staggering. People are holding one or more interim posts while others leave altogether or apply for BSW CCG jobs. The three CCGs are holding 'meetings in common' - as a workaround and to keep within the law.
The BSW CCG will cover the same geographical area as the BSW STP (Sustainability and Transformation Partnership), but the STP has a wider membership than just GP practices.
The pieces on the NHS chessboard have not yet come to rest: STPs are due to become Integrated Care Systems by 2021.
Warning! Come the start of 2020, we will have to have a close look at them and the Primary Care Networks that are integral to them. In the meantime there is a very good non party political presentation on the dangers to the family doctor/GP service - here. Well worth ten minutes of your time.
Another problem is the future function and place in the NHS hierarchy of the Wiltshire Health and Wellbeing Board (HWB) - which is a committee of Wiltshire Council. It is just one of more than 130 HWBs that were also established by legislation.
The relationship between Wiltshire CCG and Wiltshire Council has had its headline moments. A GP at Wiltshire CCG's meeting last week described the relationship as dysfunctional and questions were asked about the efficacy of the Better Care Fund which the Council runs and is funded by many millions of pounds by the CCG.
This re-shaping of the NHS is happening without the agreement of Parliament and at a terrible time for the NHS. It was said that winter was not a good time to hold a General Election which would almost certainly focus strongly on the state of the NHS.
The final preparations leading up to the CCG merger in our area are also coming while winter starts to batter the NHS. Was this timing wise?
Great Western Hospital had its first cases of flu back in September - with more in October. And a warning has gone out about the first cases in our area of Norovirus - the winter vomiting bug.
Clinicians want the public to play their part in stopping the spread of Norovirus by just thinking NORO:
N No visits to hospitals, care homes and GP surgeries if you are suffering from symptoms of Norovirus - send someone else to visit loved ones until you are better.
O Once you’ve been symptom-free for at least 48 hours, you’re safe to return to work, school or visit hospitals, GP surgeries and care homes.
R Regularly wash your hands with soap and warm water, especially after using the toilet, and before eating or preparing food.
O Only hand-washing will prevent spread of Norovirus - alcohol hand gels DON’T kill the virus.
Winter is always bad for the NHS. In recent years it has been said that - due to underfunding and the staffing crisis - 'winter-type pressures' on staff and facilities last right round the year. So if you not feeling well, get advice (NHS 111) or be seen soon before it becomes more serious and you need to go to a hospital A&E.