If you are a GP interested in working with a great group of children, and you would like to know more about palliatinve care, and care of serious conditions in children please get in touch.

Claire House, based at clatterbridge on the Wirral is a great place to work and is always looking for intertested qualified people to work with them to provide quality care to children with life limiting and life threatening illnesses.

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The development of a strategic  board of the ccg is one aspect of developing an appropriate governance regime.  BMA, DH and NHS CB guidance give examples of potential structures, but all try to avoid being prescriptive. They do however highlight the roles which need to be covered within the overall governance framework

One major aspect is that of accountability. This is described with directions as to how this can be expected to be managed externally, and suggestions towards internal accountability. This accountability belongs individually, jointly, and corporately to the board and its members, and to the whole of the CCG.

A suggested approach to managing accountability is in transparency of activity and intentions. This is about making visible and clear to everyone what is happening and why. This technique can be applied internally, and externally.  A simple approach to this is to publish all meeting notes agendas and minutes, but this relies on individuals interested in the activities of the group looking for and understanding the material. This is only a part of a fully transparent strategy.  Other important factors would include looking out for interested parties, and involving them from the beginning in developing plans and strategies, before during and after the commissioning event.  This  type of proactive structural features of transparency are worth building into the foundations of the organisation as they encourage good practice, and are hard to insert later when other practices have become established.

The importance of transparency and proactive involvement of all parties cannot be overstated. The difficult decisions which are going to have to be taken will only be successfully implemented when everyone (all interested parties) is aware of how the decisions were reached and on what information from what sources. Those most affected need to be assured that their voices have been heard, that their views have been included, and that the decision making process has been fair and open.  Whilst the responsibility will fall on ‘members’ of the commissioning group, the consequences of its activites fall on everyone within the health economy.

 

Developing an open honest culture

The development of the constitution is the first opportunity to engage everyone in the development of the CCG. In addition to the member practices and their clinicians, we need to seek opinions from the public, and the public authority, as well as key stake holder providers and partner organisations (whether NHS, third sector or for profit organisations). This may help to ensure that in writing this key document we are as inclusive as possible, and that we begin the process of incorporating transparency.  It should help to ensure that we use inclusive language which can be drawn upon to develop the legitimacy of the organisation.

Which organisations locally are our partners in developing healthcare?

There are some partners which are more obvious and others which could be considered.

Local provider trusts include our many hospitals. We have one of the largest groups of specialist trusts outside of London, especially considering the size of our city. There is one local authority which is Liverpool city council. Each of these organisations consists of a sub network of smaller organisations and it is worth considering the level of contact appropriate for each issue and for maximum engagement.

The third sector is a complex mixture of local and national groups, which are diverse in size, aims, and consistency. Identifying large organisations is relatively easy, but transparency will involve engaging as many of these organisations as possible. Some of these organisations are involved in provision of services, others are more about representing groups in society, others are a way of connecting to people around the city.

The  ‘private sector’ ; there are many organisations which operate in Liverpool and are involved directly in healthcare, in providing services, in providing advice, in providing administrative, financial or legal support. The wider community is also involved in healthcare through its involvement of its employees, their occupational health, and the access it has to large groups of people. The influence of an organisation can also extend beyond these groups, for example the media, football clubs, and arts venues have influence across many other groups.  Involvement of private sector organisations is an essential part of an open strategy.

We also need to be looking to our neighbours within the NHS, Merseyside cluster and Chester and Wirral cluster as well as other groups who share our services such as the Isle of Man, and North Wales.

The important aim in partnership working would be in using links in the most effective way for the efficient development of the local health economy, to gain support, and ideas, and to work collaboratively as part of a National Health system.

 

Sub committees

The guidance towards establishment and the BMAs guidance suggest that there are subcommittees to perform audit/oversight and other functions. Locally we have discussed some network of localities with neighbourhoods within them to address engagement and involvement. It is important that we draw from these effectively, and don’t end up with too many or too few places for discussion to replace decision. In particular whilst representation from different constituent localities will be needed in some areas, in more activity based groups it may be useful for the committee to be represented in the locality, more than the locality in the committee

Of course the Health bill has still to go through, but who controls the Health service at present?

The GPs are set up as CCGs to take over from the PCTs, but the PCTs are now where the SHAs were and the SHAs are a new Cluster SHA under the NHS executive.

This means that when the CCGs are keen to get on with the job they are dependant on agreement from the DoH, NHSexec, Cluster SHA, and Cluster PCTs. Which is not too bad if they all agree.

Imagine then a situation where the PM and health sec agree to  CCGs of various models, in order to try things out. What would happen if the NHS exec decided to block this by adding its own criteria. Then the Cluster SHAs add their own criteria, then the cluster pcts. Pretty soon you end up with no changes at all again.

But why imagine?

 

criteria for authorisation of CCGs will be:
strong clinical and professional focus
meaningful engagement with patients
clear and credible plans to deliver qipp
proper constitutional and governance arrangements with capacity and capability
collaborative arrangements
Great Leaders!

I’m wondering if you can help me with something… I’m trying to reach out to GP’s in the area who might want to work in the prisons in the area. Do you think it will be possible to circulate and email to all your doctors asking them this? Regards Phil Please see our new website… http://www.med-co.com

Philip Hill – MIRP CertRP Senior Recruitment Consultant – HM Prisons Med-Co (Europe) Ltd Canolfan Gorseinon Centre Millers Drive Gorseinon Swansea SA4 4QN Tel: 01792 224224 Fax: 01792 224225

Having rushed out a health bill that no one wanted, even getting through a committee stage, it seems that the momentum has been lost. The political risk to the coalition government has become to high. This leaves GPs in a dilemma, in those areas where the changes have progressed especially. Do they continue to make the changes needed for the ‘new’ model? or can the ‘old’ model be reconstructed?

Of course this doesn’t really matter. General Practice and the NHS works best when working in an integrated fashion. Cooperation between practices to produce better primary care has always been possible and consortia are simply the new name for PBC, and PCGs. Without some of the proposed changes there may be less scope for direct involvement in managing the local health economy, but the indirect effect of GPs working together remains.

Salaried GPs, locum GPs and partners who want to be involved in local medical politics will get involved. Those who want to get on with their day to day practice  will continue to receive new directions to work towards.

If you want to add your ideas and thoughts on to this site please let me know.

The locum list is still valued, with new people being added and others moving on when no longer working as locums.

Increasing the interest in the site will make your locum list more noticeable to local practices and may get you more attention.

Apply below…

Also don’t forget to get involved in your local consortia, they will be acting for you however you are employed.

a good consortium website is that of  west cheshire

There is a vacancy advertised for the wirral LMC sessional GP representative. Nominations have been requested, and voting will commence if there is more than one candidate.

Representatives for non-principal GPs have been elected on several occasions. The election is usually preceeded by an attempt to gather names and addresses and ‘permission to be contacted’. Then everything goes quiet.

The LMC represents all GPs regardless of how they are employed. It ‘s functions are paid for  in 2 ways. Some from central funds, and others from the ‘voluntary levy’. It is this voluntary levy which has caused part of the discrimination by some against independant GPs and limited communication.

Some of you may have had another request  for ‘permission to hold your details’  perhaps now the LMC is trying to contact nonprincipals to establish ongoing links. Hopefully this will help to engage them and us to benefit all GPS, especially as more and more are not principals.

As a locum you are the last independants in an increasingly managed system. In GMS, the independance of action is increasingly restricted by PCT or QOF government or ‘public opinion’. As PMS is bought out by Sainsburies there will be increasingly bizarre managerial involvement.

How do you chose to use your independance? Do you work when you want to? Do you charge practices, or do they offer you a payment? Do you describe the services you offer specifically, or do you just ‘do what you gotta do’ ?