Agenda item
North West London Commissioning Reform Case for Change
To receive a report from Brent Clinical Commissioning Group (CCG) updating on progress with the commissioning reform in the North West London Collaboration of CCGs and the decision of Brent CCG to move to a single CCG in 2021 in light of the need to focus on financial recovery along with a move to a single operating structure across North West London.
Minutes:
Mark Easton (Accountability Officer, North West London Clinical Commissioning Group - CCGs) introduced the report, updating the board on the progress with the commissioning reform in the North West London Collaboration of CCGs and the decision of Brent CCG to move to a single CCG in 2021 in light of the need to focus on financial recovery along with a move to a single operating structure across North West London. Mark Easton explained that there was an engagement process that took place in order to make a decision on when to go ahead with the merge, and the outcome of those discussions, agreed by all 8 CCG governing bodies, was that the merge would take place in April 2021. Next, there would be conversations regarding a constitution and there would be an Equality Impact Assessment for the proposal, which were felt to be sufficient arrangements for public assurance and scrutiny.
The Chair thanked Mark Easton for introducing the report and invited questions from the Committee. The Committee asked for reassurances about patient safety. Mark Easton agreed that safety was paramount and was to be looked at carefully. It was stated that a risk log would be kept and there would be conscious monitoring to ensure the change in governance and management did not impact patient safety.
The Committee queried whether the deficit would be higher once the merge occurred. Mark Easton answered that they were still awaiting an answer from NHS London regarding the way in which the deficit would need to be treated.
Regarding the additional roles reimbursement, the Committee wanted assurance that the CCG were confident they could recruit more staff. Fana Hussain (Assistant Director for Primary Care, Brent CCG) responded that they were taking a phased approach to recruitment. It was confirmed that there was already a full complement of pharmacists, and that specific organisations were working with the CCG to recruit staff, such as University graduates. It was felt that there would be sufficient paramedic trainees to recruit in year 3 of the plan. With regard to responsibility for staffing in Healthcare Services, Mark Easton informed the Committee that all existing staff would transfer to the single CCG. The Committee were informed that cost reduction would be focussed on back office services rather than patient facing services.
Engagement from the community was also a priority for the Committee, with questions regarding the level of turnout for the 130 engagement events referred to in section 3 of the report. Mark Easton confirmed that some of the events had very good engagement while others were more intimate, but felt confident that they had reached all interested parties. Ian Niven (Healthwatch, Brent) summarised some of the responses from the Brent patient participation group; most respondents were concerned about point of care rather than governance, some were concerned about the population of North West London, lack of Primary Care Networks and there was also a feeling of concern regarding the delivery of savings. Ian Niven suggested that the patient voice should be included in the reports and that some FAQs were created. The Committee further queried the engagement from those with multiple indices of deprivation, to which CCG representatives responded that it was difficult to engage the community as the plan was so heavily related to governance rather than access to services. It was pointed out that the aim had not been to target everyone but to focus the consultation on those interested in the way the NHS was organised. Sheik Auladin (Managing Director, Brent CCG) added that there was positive engagement from GPs.
Committee members were concerned about accountability and autonomy for Boroughs. Mark Easton explained that the NHS operated at different levels of scale, and that currently there was no governance at North West London level but within each individual Borough. Mark Easton argued that with the proposed change CCGs would be reinvented as strategic, and local presence would be seen as a partnership, with Lambeth and Croydon given as examples of joint management arrangements. It was argued that this was an opportunity to design locally facing democratic management with local engagement where local leaders would make up the governing body and Brent would have a representative. Regarding the autonomy for local Borough’s Mark Easton clarified that they would aim to seek formal partnership arrangements with Boroughs.
As no further issues were raised, the Chair thanked the Committee for their scrutiny and invited recommendations from the members. The Committee RESOLVED to recommend the following:
1. To request that the CCG guarantee that the new structure will include local governance arrangements with lay people to be fully involved.
2. To request that should the proposals for a single CCG proceed, this is seen as an opportunity to further develop and integrate health and social care provision within the new structure.
3. That the CCG be requested to report back to the scrutiny Committee before any final decision is made regarding the new structure in relation to both the financial position and lessons learnt as a result of the shadow arrangements currently in place.
Supporting documents: