Taking the lead

AS well as working for an organisation with one of the longest names in England, Dr Vicky Pleydell probably has one of the longest job titles.

The shadow clinical accountable officer for Hambleton, Richmondshire and Whitby Clinical Commissioning Group (CCG) believes the new way of commissioning most NHS services that will come into effect in April next year will bring benefits.

The CCGs will formally take over the bulk of NHS spending when primary care groups are abolished in April next year, but they are already heavily involved in key decisions.

The Hambleton CCG is taking a leading role in a highly controversial process – assessing whether children’s and maternity services at the Friarage Hospital, in Northallerton , should be downgraded.

Dr Pleydell says the CCGs have finally put the clinicians – mostly GPs, but with some nurses and hospital consultants – in charge of spending decisions.

For Dr Pleydell, who is a partner at a Catterick Garrison GP practice, that has been a key factor in winning support from doctors.

She said: “There has been a huge change this year in the attitude of GPs. They now understand the role they have been given and they really want to get involved.”

Because GPs cannot opt out of the new arrangements, every GP is now part of the new structure.

A governing group has been set up that works on behalf of a council of members, with one GP from every practice represented.

It also has a co-opted representative from thelocal council and will eventually have two patient representatives.

While the CCG will employ only about 20 administrative staff, based at a temporary office in Thirsk , it will also buy in expertise on commissioning matters.

For Dr Pleydell, one of the most important principles for the CCG is the idea that health services should be provided as close to patients’ homes as “clinically appropriate”.

That will mean more resources being switched from larger general hospitals and invested in local, community-based services such as smaller, local hospitals. That will be combined with improved access to GP services and non-hospital care when it is needed.

Dr Pleydell said: “We have to make sure that only the people who need to go to hospital actually go.

“We are asking our acute hospital trusts to invest more in community teams and to try to discourage unnecessary admissions.

“Far too many people get stuck in hospital because the right facilities are not at home.

Something small can happen and then people are not able to support themselves because we do not have a community infrastructure.

“They might just need a very short stay in a community hospital or a nursing home, a bit of rehab and then support once they get back home.”

Another key principle for the CCG is to ensure that services are safe and sustainable.

Dr Pleydell says putting health professionals in charge has broken down artificial barriers between NHS staff working in the community and their colleagues in hospitals.

She said: “There has been a nervousness on the part of consultants, but there is now a much more open discussion.”

Dr Pleydell is extremely interested in using the voluntary sector to support patients in their homes who might otherwise be admitted to hospital.

She said: “There are some schemes which have involved commissioning services from charities like Age UK and the Red Cross, and we need to look at all of these ideas. Everybody in the health service is very much aware of the financial and demographic challenges we face.

The answer isn’t just spending more money.”

Like Dr Pleydell’s patch, the area covered by Dr Stuart Findlay’s CCG area in County Durham is enormous.

“We cover all the way from Easington in the east to half-way up the Pennines in the West,”

says Dr Findlay, who is chief clinical officer of the Durham Dales, Easington and Sedgefield CCG.T HE long-serving Bishop Auckland GP is enthusiastic about the new system and says it has come at just the right time.

He said: “With the financial position in the country, we need to find a way to make the NHS as efficient as possible, and we think this new way of working will help us do that.”

Dr Findlay echoes Dr Pleydell when he says one of the best ways to improve care and reduce costs is to move as much healthcare as possible to community providers such as district nurses and smaller community hospitals.

He said: “We are also hoping we will be able to better engage with our patients. We have been around all of our different practices, asking people what their priorities are in commissioning.

What comes up again and again is transport, which is a huge issue in the Durham dales.”

Like the Hambletonshire CCG, Dr Findlay’s CCG is a dramatically slimmed-down version of the PCT, with only 12 administrative staff.

It will also buy in commissioning expertise from a central North-East Commissioning Support office in Durham City, the current base of County Durham and Darlington PCT, which will be abolished in April.

Dr Findlay, who will continue to work as a GP one day a week while running the CCG, believes the new system will serve patients well.

He said: “I believe small groups of GPs together with patient representatives can make decisions and put them into practice very quickly.”