On 13th February the Department for Health laid before Parliament new statutory regulations governing procurement and competition. They will govern procurement by Clinical Commissioning Groups like the South Reading CCG after 1st April. The regulations and the official explanatory memo are attached.This followed a consultation last year. While they give welcome rights to patients, there are areas for concern, especially in that they require "best value" although the Health and Social Care Act 2012 ruled out competition on the basis of price. 

Statutory regulations are not normally debated by Parliament byt the organisation 38 degrees is petitioning for a full debate in this case
38 degrees petition
The attached response to consultation from the Patients Association raises some concerns.
  
The Health Service Journal commented, "Lawyers working in the NHS told HSJ the regulations could have wide-reaching implications on the mix of providers of NHS-funded services. The rules ban any restrictions on competition that are not necessary. They say contracts can only be awarded without tender for technical reasons, or reasons connected with the protection of exclusive rights or for reasons of extreme urgency.

Dr Chaand Nagpaul, chief negotiator of the British Medical Association's General Practitioner Committee is quoted in Pulse magazine as saying, "These regulations are placing a compulsion on CCGs to use competition by default, with exceptions to this occurring in defined instances. I think that reneges on the commitment given by Government to CCGs at the passing of the bill.

An ideological requirement for competition will be bureaucratic and will force CCGs to commission with the private sector. The last thing CCGs need is to be spending all of their time putting out every service to tender. There is a huge bureaucracy and expense involved in processing tenders.

it will affect GPs because the last thing we want is for CCGs to be incurring expense, delay of going through tendering processes, but also we dont want GPs as providers to be putting unnecessary time and expense into tendering for services either."

The minutes of the CCG Authorisation Sub-Committee from December show that the NCB before authorising the Berkshire West CCGs, did have concerns over the structure of the Berkshire West Federation. In particular how one Accountable Officer would be responsible for four CCGs, as shown by the following extract from the minutes: (SPD is Dr Sarah Pinto-Duchinsky - head of CCG authorisation and BH is Dame Barabara Hakin National DIrector of Commissioning Development) 

 

• 27 SPD moved to present the Berkshire West Federation of four CCGs, which includes Newbury and District CCG, North and West Reading CCG, South Reading CCG, and Wokingham CCG. The federation intended to have one Accountable Officer and one Chief Finance Officer shared across the four CCGs.
• 28. BH outlined that the moderation and conditions panel had agreed to bring the most significant issues for resolution to the sub-committee and highlighted that the Berkshire West federation was considered to be the most difficult issue to be resolved in wave one. The main issue with Berkshire West federation was how one AO would be able to service four separate governing bodies at the same time as running the four CCGs on a day-to-day basis.
• 29. SPD explained that their view had been that the individual CCGs had been so focussed on the creation of their four individual sets of arrangements that they had not concentrated on how they would work as a collective. The assessments had been careful not to pass judgement on the designate AO as an individual but rather expressed concerns that the current arrangements would not be adequate to support all four CCGs.
• 30. The sub-committee discussed the issue and concluded that the federation should be asked to review its governance functions in order to ensure that the AO and other directors would be able to function effectively.
• 31. The sub-committee approved the recommendation to appoint the AO with these assurances.
• 32. SPD confirmed that the recommendation to the sub-committee was to authorise each of the four CCGs with conditions.
• 33. The sub-committee approved the authorisation each of the four CCGs within the Berkshire West federated CCGs conditions.

The South Reading Clinical Commissioning Group is now authorised and operational as of 1st April 2013. Its website is at www.southreadingccg.nhs.uk and its twitter name is @SReadingCCG.
 
The local Berkshire West federation of Clinical Commissioning Groups has set up a website about Diabetes and Diabetes care. We have retaned a few CCG documents here temporarily. 
 
The documents here are the CCG constitution in four parts - currently in shadow form but very close to what it will be - and the DRAFT "plan-on-a-page" required by the National Commissioning Board - to give an outline of the CCG's plans for the financial year 2013-14. . 
 
Then we also have the South Reading CCG draft plan for 2013-14 and the Health and Well-Being Board's Strategy for 2013-14 to which the plan referers. 
 
Primary care performance indicators (2012): South Reading CCG QOF Indicators for 2012 

We will be meeting between 6pm and 7:30pm on Wednesday, 27th February 2013. The main topics for discussion will be the new 111 non-emergency phone service and an update on the South Reading CCG.

The South Reading Patient Voice will meet at the University Health Centre on Northcourt Avenue at 6pm-7:30pm on Wednesday, 27th February 2013.

On 1st February, the local branch of the national 38 degrees campaign presented a petition to the South Reading NHS Clinical Commissioning Group as part of their national campaign. The petition was presented by a small group of supporters and received by Dr Elizabeth Johnston on behalf of the CCG. The text read 
"Our NHS is precious, and we're relying on you to protect it. Please do all you can to stop local health services being broken up or taken over by irresponsible private companies.

 

• Protect local NHS services and consult patients properly before making changes
• Spend money wisely and dont do deals with irresponsible private companies
• Adopt policies and a constitution which reflect these values

"

At the meeting of 30th January the national AQP (any qualified provider) programme was discussed. Each commissioning trust had been obliged to choose three areas to open up to multiple suppliers. In Berkshire the areas are Adult Hearing (tests and provision of hearing aids with follow up), Non-Obstetric Ultrasound (scanning but not of the unborn child) and Podiatry (Foot care). Where there are multiple suppliers the patient chooses with the help and advice of their GP. who provides the referral. For Adult Hearing the five suppliers are: Berkshire Healthcare NHS FT, Royal Berkshire NHS FT, Royal Surrey County Hospital NHS FT, Specsavers Hearing Group Ltd. and Sussex Healthcare Audiology Ltd whose services are operational; for Non-Obstetric Ultrasound the five suppliers are: Care UK Specialist Medical Imaging Ltd., Diagnostic Health Systems Ltd., Global Diagnostics Ltd., Physiological Measurements Ltd., Royal Berkshire NHS FT where so far contracts have been signed; for Podiatry there is one supplier, Berkshire Healthcare NHS FT whose contract has been signed. 
  
Concerns were expressed about the fragmentation of services, about the increased complexity of the GP's task, about the possibility that the 20% or so patients with more complex needs might not be referred to the Royal Berkshire NHS FT, about the sustainability of the full range of audiology services at the Royal Berkshire NHS FT. Additionally one of the audiology suppliers was thought to operate a franchising structure.
 
The group passed a resolution that " Patient Voice was not given enough information to give considered and constructive comment on the choice of services suitable for Any Qualified Provider and had there been sufficient information it would not have recommended audiology".

From April 2013, NICE will develop a library of quality standards and guidance to improve the quality of care and support, in consultation with the care and support sector, care users, their families and carers. The Department for Health is issuing a consultation document on social care standard - responses to be in by 20th April 2013. Locally Healthwatch, the successor to LiNK, will take on the role of consumer champion for Social Care as well as for Health.

The South Reading Patient Voice will meet at the University Health Centre on Northcourt Avenue at 6pm-7:30pm on Wednesday, 30th January 2013. The Agenda will include presentation and discussions on AQP (any qualified provider - the Government's choice of supplier approach), the progress of the CCG and the commissioning plan for South Reading. This is a chance to get an understanding of the coming shape of our health services as the new arrangements finally take shape.

In a paper to be considered at the (shadow) Health and Well-Being Board on 25th January 2013, Reading Borough Council has published its response to the public consultation on Reading's Health and Well-Being Strategy for 2013-14. Please see the attached link for access to this paper. Much of the comment is in the way of fleshing out the strategy and changing or introducing new points of emphasis. It is stressed that the strategy is an evolving document.