Is there a role for a paediatrician in the NHS clinical commissioning group?

Abstract

Commissioning is the planning, purchasing, reviewing and refining of NHS services to meet the health needs of a local population. The idea of commissioning as discrete purchaser/ provider function within the NHS dates back to 1991. The NHS and Community Care Act in 1990 created two models of commissioning; one based on health authorities and the other based on general practice. Under General Practitioner (GP) fund holding GPs held real budgets with which they purchased nonurgent elective and community care for patients. Some GP practices came together in consortia creating larger organisations to pool financial risk and share resources. The Labour government abolished GP fund holding in 1997, but retained purchaser/provider split. Health Authorities were replaced by primary care groups and then primary care trusts (PCTs). In 2004 the government announced a new form of GP commissioning e practice based commissioning though this was not compulsory. Over the last 10 years the role of commissioning as a key driver for quality, efficiency and outcomes for patients has become increasingly important to the health system in England. The NHS commissioning system previously consisted of PCTs and specialised commissioning groups. The Health & Social Care Act came into force from 2012 and radically altered the health and social care landscape, and the way health services are commissioned with GPs in charge of commissioning through their local clinical commissioning groups (CCGs). Most of the NHS commissioning budget in England is now managed by 211 CCGs. These are groups of general practices which come together in each area to commission the best service for their patients and populations. Nationally, NHS England commissions specialised services, primary care, offender healthcare and some services for armed forces. It has 27 area teams but is a single organisation operating to a common model with one board. The aspiration is undoubtedly to commission a high quality service for every patient. The challenges, as can be imagined, are many not least because of current financial constraints but also because of the variation in advice and expertise available to CCGs with regards to commissioning the best possible holistic services for children, young people (CYP) and their families. There are a number of national guidance/documents available to enable children’s commissioners in the NHS to put their plan in the context of their local joint strategic needs assessment