Is this seat taken? If you mean the much-touted “CCG driving seat”, then definitely “yes”. The driving seat for this commissioning road trip is “shared space”. According to Pulse, that’s a reason for wailing and rending of garments. It surveyed 100 CCGs (out of 212) and found GPs occupying less than half of the seats on new CCG boards and only a fifth in some parts of the country. Shock horror!
The sky is not falling
In GP tabloid-land the sky is always about to fall in and there are wonderfully grumpy comments, like this one reacting to Pulse’s breathless “investigation”: “Let’s not get back to this silly ‘involve the patient/lay person/vicar/idiot’ mentality just when we might be getting somewhere. You asked the GP’s to run the show, and we should run it.”
GPs should grow up about CCG governance. Did they really think the driving seat was reserved exclusively for private contractors? “Clinically led” doesn’t mean “GPs only” and primary care isn’t a synonym for general practice. As Mike Dixon said recently, the lack of GPs on boards isn’t a big deal: “Corporate governance is not that sexy for clinicians. Clinicians want to change services.” Exactly – that’s what clinically led means.
Just follow the guidance
There is plenty of new guidance about how to appoint lay members to CCGs. Following it should produce some top-notch lay people to take oversight roles for governance and engagement and make a real leadership contribution to each CCG. CCGs won’t succeed without lay leadership to go with clinical and management leaders.
I was on an inner London PEC for 10 years and was just as frustrated most of that time about really changing things as my clinical colleagues were. Post liberation, like it or not, CCGs are about to find out how exposed they are. That’s no bad thing if it drives openness of decision making and accountability. The test will be when CCGs have to act more like “CDGs” – “Clinical Decommissioning Groups” as the Nicholson Challenge rolls forward towards 2020. To succeed, they need strong community support for change.
Having a strong lay leadership element in the CCG should empower GPs to lead change. That’s why CCGs need a shared driving seat and everyone in it needs a common understanding of where the CCG is going to go. Everyone in the CCG – top to bottom – should have the same vision of how to do things better and more efficiently, not just the GPs.
Lay value for money? how will we know?
There will be at least 424 lay members of CCG boards. Locally we are paying each of ours £12,000 pa. If that’s the standard reward level across England, what will CCGs get from their lay members in return for £5,088,000 every year? I hope someone, somewhere is going to find out. In the meantime, for those CCGs still unsure about how to do it, I recommend a bit of light bedtime reading: David Gilbert’s succinct “Working with Lay Members and Patient Representatives” title in the new Smart Guide to Engagement series. All they need to know in 2000 words and written just for them.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.