In less than a year the controversial NHS reforms will be implemented. Health Editor Barry Nelson reports on the gradual transformation of a much-loved and vital service used by everyone

TO say that the headquarters of NHS County Durham and Darlington feels like the Mary Celeste is probably an overstatement. But like the fabled ship – found abandoned without a crew – a visitor to John Snow House, in Durham City, would struggle to find many office workers compared to a couple of years ago.

This is because the coalition Government is pressing ahead with plans to drastically reduce administrative and management costs in the NHS and hand over most of the Health Service budget to groups of GPs.

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In the past 18 months, the headcount at NHS County Durham and Darlington has dropped by 120, from about 500 to about 380.

Only two members of staff were made compulsorily redundant, with others choosing to leave before the axe fell.

Even Pat Keane, the primary care trust’s (PCT) deputy chief executive, who has been overseeing the downsizing needed to prepare for the new era, will also be looking for a new job come next April 1 when three new Clinical Commissioning Groups (CCG), led by family doctors, take over the planning and commissioning of most NHS services previously managed by the PCT.

Mr Keane, who started as a nurse at North Tees Hospital in Stockton 34 years ago, says his job in the 11 months remaining is to ensure that there is a smooth handover to the new regime.

Of the remaining staff, the majority will probably be taken on by the new Commissioning Support Service or CSS, which seems likely to be based at one central point – probably in John Snow House on Durham University’s Science Park, which the NHS already owns.

The CSS will provide the technical expertise that will be needed by the new GP-led commissioning groups when they take over a mindbogglingly complex budget of more than £1bn.

The rest of the staff are likely to be split between the three groups – Darlington CCG, North Durham CCG and DDES CCG (standing for Durham Dales, Easington and Sedgefield) – although, ultimately, it is up to the GPs to decide how many staff they take on.

While Mr Keane says there are currently no plans to cut jobs any further there may be some further reductions before the new system is bedded in.

“The CCGs know what they need in terms of their teams. The debate is still going on about the size of staff and we should know how many are needed by June.”

Currently, the PCT is holding an estates review, looking at buildings which have become surplus to requirements.

While the Health and Social Care Bill has only recently been passed – after a titanic political struggle – PCT budgets were handed over to the three shadow CCGs last month.

The CCGs are now sub-committees of the PCT board and have responsibility for spending hundreds of millions of pounds.

However, until April 1, next year – when the PCTs will be abolished – the CCGs will still need to have spending plans approved by the PCTs.

So far, things have gone relatively smoothly but Mr Keane is aware of the need to keep on top of the situation.

“My job is to keep a grip during the transition. We have a fantastic record as a PCT in terms of always meeting our targets. We don’t want to take our eye off the ball and hand over a bust system.

We want to leave a strong legacy.”

OVER on Teesside, Dr Boleslaw Posmyk, the Hartlepool GP who has just been elected by his colleagues as chairman of the new NHS Hartlepool and Stockton on Tees CCG is getting used to his role.

Like his colleagues in the rest of the region, he has been on a sharp learning curve, getting to grips with the complexities of the NHS budget that he will soon be overseeing.

“The PCT is still the statutory body so we are working in a shadow format until next April,”

says Dr Posmyk.“We have to answer to the PCT board that what we are doing is in the best interests of patients,” he adds. His CCG took a big step forward recently when Hartlepool and North Tees PCT approved its budgetary plans for the year ahead.

Dr Posmyk says the changes to the NHS have encouraged more of a dialogue to take place between GPs, between family doctors and hospital doctors and between GPs and council officials working in social care.

“We are seeing a breaking down of the silos which divide professionals. We are also developing a joint strategic needs assessment which forms a core part of our commissioning plans,” he adds.

Dr Posmyk says GPs are well placed to listen to patient concerns and were mindful of the Mid-Staffordshire Hospital scandal.

“The main lesson is that you don’t become complacent about the safety and quality of the service you are providing. Feedback from patients must be taken seriously and investigated,” he adds.

AS a GP who decided to move into the new One Life Hartlepool “polyclinic”, in the town centre, Dr Posmyk is keen on providing services closer to where patients live.“We are concentrating on keeping services in the community as much as possible. Where possible, we will be moving some outpatient services out of hospitals and into the community.”

Dr Posmyk says the overall aim is to provide a good quality, more local, more convenient service – within a budget.

The CCG might choose to shift resources to more deprived areas but GPs are also looking at improving services in more affluent places, such as Yarm and Eaglescliffe – by persuading hospital consultants to hold clinics in those areas.

All the new CCGs in the region will be hoping they satisfy stringent competency tests and are allowed to take full control next April.

CCGs which need more time will be supervised by a new NHS Commissioning Board, in Leeds, until they are ready to fly solo.

Whatever the future brings, Dr Posmyk says he and his colleagues are determined to do their best for patients.