The new clinical commissioning groups (CCGs) must be held accountable for how they are performing, but they also need "some amount of discretion" to allow for innovation that will advance their patients' care, say MPs.
This recommendation emerges from the latest enquiry into the NHS reforms by the All-Party Parliamentary Group (APPG) on Primary Care and Public Health, which concludes that there has been no real need for a wholesale restructuring of the Service in order to make it more efficient.
"We see the advantages of moving towards a more clinician-led commissioning health system, but we feel the grand scale of the reforms was unnecessary, since the system was already moving towards greater clinical involvement in commissioning as a result of practice-based commissioning and world-class commissioning," says the APPG's secretary, cross-bench peer Baroness Masham.
Other concerns expressed by the APPG include accountability and variation in performance between CCGs. "We have to minimise the possibility of post-code health care, which means it is imperative that structures and frameworks around CCGs' performance are scrutinised by the NHS Commissioning Board," says APPG co-chair Julie Elliot, Labour MP for Sunderland Central.
Among the inquiry report's other recommendations are for:
- those responsible for meeting Quality, Innovation, Productivity and Prevention (QIPP) targets to be given the freedom to focus on them without being overburdened with bureaucracy or matters concerning the restructuring;
- providers of care to work together to deliver QIPP rather than competing, and for public health expertise and input to given to help meet QIPP targets;
- CCGs to invite patients and the public onto their boards, which should also include other representatives of the health care community such as pharmacists, nurses and practice managers, in order to ensure that services meet the needs of the whole population;
- primary and secondary care to work closely together to manage appropriate hospital admissions;
- a national debate on health service provision, to enable patients and the public the understand where there is, and is not, a need for medical intervention;
- CCGs to build mechanisms into their strategies to support self-care, and that this is central to all consultations;
- the development of multidisciplinary teams, which include public health expertise and CCGs, to focus on strategies to turn around the "dependency" culture and enable greater support for people to look after themselves;
- all schools to employ nurses to educate children about their health, helping them to become responsible healthy citizens; and
- the NHS Commissioning Board to hold CCGs to account for their systems, with processes to demonstrate on-going, effective and appropriate public and patient involvement and influence.
- Meantime, Health Secretary Andrew Lansley announced this week that doctors in emerging CCGs will receive up to £100 million in additional funding to improve local services and reduce pressures on the NHS during the colder months.
Clinicians in the CCGs will spend the money directly on local care services that best meet their patients' clinical needs and prevent unnecessary admissions to hospital, said Mr Lansley, who noted that this will be the first time that the Groups have been given money to spend on services for patients.
"This additional funding, available due to good management of the Department [of Health]'s central budgets, will harness the expertise of local clinicians who know, better than anyone, what their patients need," he said.