PHP21 How Will the New NHS Decentralised Reforms Impact on Access to Medicines in England?

Abstract

With the formation of Clinical Commissioning Groups (CCGs) GP Practices will come together to commission services for their local populations. However, freedoms to be delegated from the Clinical Commissioning board may mean that considerable ‘command and control' will still be exerted from the centre. Secondary and primary research was undertaken to gain insight into how devolved locality based commissioning is likely to impact on access to medicines. We reviewed 35 first wave CCGs in terms of population coverage, financial stability and current Primary care Trust (PCT) activities in relation to Practice based commissioning. We then interviewed 5 NHS Experts to assess whether these CCGs would be allowed the aspirational freedoms referred to in the 2012 Health and Social Care Act- in particular prescribing freedoms formerly under the guidance of PCTs. Various information sources were used Care Quality Commission, Audit Commission, and Health Select Committee reports to support the interpretation of the findings. The selected CCGs represented an homogeneous group of practices in that they had previously demonstrated financial stewardship and collaborative working with their ‘host' PCTs. Many CCGs had been devolved the Commissioning budget by their PCTs and were routinely involved in setting up medicines management protocols with their provider hospitals. Almost half of the CCGs had coterminous medicines management contracts shared with their PCTs. NHS experts raised issues around corporate and clinical governance and how practices would fundamentally want to take on the devolved financial responsibilities. The NHS reforms mean that £60 Billion of the total health care budget will be under the control of CCGs. PCTs and Strategic Health Authorities will be abolished and with a watered down role for NICE postcode variation may be rife; access to medicines will continue to be fraught with many layers of decision making and further delays.