Dr Richard Preece, who is representing the Faculty on the Academy of Medical Royal Colleges Clinical Commissioning Group, has written a briefing for colleagues on the emerging shape of clinical commissioning under the terms of the new Health and Social Care Act.
The Health and Social Care Act is now being implemented. It will be some time before the full implications for occupational medicine are known. The Act introduces important changes to the way healthcare is commissioned. It seems certain that this will have an impact on NHS OH services in England but there is the potential for much wider impact in the coming years.
The (National) NHS Commissioning Board has been established as an Agency. Its role is to use the resource allocated to the NHS to achieve the outcome objectives for patients set by the Department of Health. Clinical leadership for the Commissioning Board will be provided by the NHS Medical Director and Chief Nursing Officer supported by Domain leads and other clinicians. The Commissioning Board has recognised there are some so-called ‘orphan areas’ that haven’t got a nominated National Clinical Lead yet – it is possible this includes occupational medicine.
The detailed arrangements for commissioning are complex and so difficult to describe succinctly. They include sub-national arrangements and local structures (Clinical Commissioning Groups – CCGs). The precise structures are still emerging but include roles for groups of clinicians (Senates) to influence commissioning. Local needs for health and social care will also be guided by Health & Wellbeing Boards (http://healthandcare.dh.gov.uk/hwb-guide/). It is clear that the membership of these different groups is developing in different ways in different locations.
The detailed arrangements for the sub-national Strategic Clinical Networks are currently being developed by the NHS Medical Director. They will have standard Terms of Reference and initially be established for five years. There are likely to be about fourteen with some alignment to other sub-national structures such as academic health science networks and Local Education & Training Boards (LETB). The design and implementation of the Strategic Clinical Networks should be complete in the next few weeks.
It is intended that Clinical Senates will provide unbiased, strategic clinical advice and leadership, that is not condition focused, to CCGs, Health & Wellbeing Boards and the Commissioning Board within specific geographical areas. The Senates’ role will be to use detailed knowledge of the local health system to assist commissioners to put outcomes and quality at the heart of the commissioning system and promote the needs of patients above the needs of organisations or professions. The exact role of Senates is in the process of being tightly defined. It is envisaged that the Senates will have a core steering group but with a much wider membership that extends beyond the NHS. The detailed arrangements for Clinical Senates should be completed by July.
Occupational physicians interested in participating in Strategic Clinical Networks and Clinical Senates should stay alert to emerging news from the NHS Commissioning Board, Department of Health, and elsewhere. Useful information can be found at http://www.commissioningboard.nhs.uk.
Local information is also likely to become available from Clinical Commissioning Groups and Health & Wellbeing Boards, and from the medical leadership of local NHS organisations. Local arrangements are changing continually. Information is usually found relatively easily using an internet search. Once key local contacts have been identified it should be possible to directly enquire when and if there are opportunities to get involved.
The Faculty, with the other members of the Academy of Medical Royal Colleges, is participating in discussions with the Commissioning Board as the new arrangements for clinical input to commissioning emerge.
A special edition of “The Month” – an NHS CEO briefing on the Health and Social Care Act, which covers many areas of interest to members including an update on clinical commissioning: http://www.dh.gov.uk/health/2012/03/the-month-special-march-2012/
A helpful map of clinical commissioning groups: http://www.binleysonline.com/clinicalcommissioninggroups/