A NEW era for the NHS in Oxfordshire starts today.
But the new GP-led organisation needs to find savings of £25.6m in the first year to meet its budget of £650m – with up to £4m still being sought as the Oxford Mail went to press.
Bosses of the Oxfordshire Clinical Commissioning Group (OCCG) say they hope to save cash by reducing the number of patients being sent to hospitals.
They plan to stop “inappropriate” GP referrals to hospitals and improve doctors’ knowledge of alternative ways of treating patients.
But they have also promised care will become more patient-centred, with those making the decisions still working on the frontline.
The OCCG, led by Dr Stephen Richards, replaces the Primary Care Trust (PCT) in buying most hospital and community health services for local people.
It has also made seven redundancies – with possibly one more to follow – and one early retirement.
Clinical commissioning groups were created by the Government to move away from the manager-led commissioning of PCTs and bring clinicians, including GPs, into the process.
The groups will commission non-emergency operations, common cancers, district nursing, and ambulance, accident & emergency, maternity, mental health and community services.
But the changes have proved controversial, with some labelling them privatisation through the back door, while others are concerned about GPs having conflicts of interest.
OCCG chief clinical officer Dr Richards said the biggest challenge would be managing budgets while maintaining patient safety and healthcare quality.
The OCCG Operational Plan warns: “The pressure on the starting point for 2013/14 means that there is a significant risk to the delivery of the objectives in year one of the financial plan.”
Dr Richards said Oxfordshire was the third or fourth lowest funded such group in the country because it was seen as relatively healthy and affluent.
But he vowed frontline services would not be cut.
He said: “There will be radical solutions. We need to use resources in community hospitals better.
“We also need to find ways of moving care closer to people.
“We will be working across health and social care to increase care in patients’ homes.
“We are looking to reverse the trend of increased urgent admission to Oxford’s John Radcliffe Hospital and Banbury’s Horton Hospital.”
But Patient Voice chairman Jacquie Pearce-Gervis said: “I think patients are confused. They would like to know what difference this will make.
“People are hoping it will mean a greater say in their care and where they can get it.”
And Kelvin Aubrey, of the health workers’ branch of the union Unison, said: “The whole operation has led to massive disruption of NHS back office functions over the past 12 months, while staff had little idea of their futures.
“The pressure on CCGs to privatise services in an attempt to save money will be intense.”
Dr Richards said efforts would be made to slash the number of “unnecessary” outpatient follow-up appointments, while a new system would ensure better links between GPs, consultants and commissioners.
The new organisation also faces the additional challenge of operating with a staff of 95 compared with 223 people who had been employed by Oxfordshire PCT.
Clinical board members, including Dr Richards himself, will still work at their GP practices.
Dr Richards, who works one day a week at his Woodcote practice, said: “It is not over-stretched. It is do-able.
“It is extremely valuable, both to maintain contact with patients and to understand the challenges facing GPs and their teams.”
Dr Richards said the timescale of the changes, set by the Government, had been “extremely tight”, but said the group was in a good position.
OCCG is the fourth largest in the country and is one of the first of 212 proposed such groups to be approved by the Government.
The group has also brought in a software system, called Datix, which links GPs and patients directly to OCCG to give suggestions about improvements.
HOW THE OCCG IS MADE UP
OXFORDSHIRE Clinical Commissioning Group is made up of 83 general practices across the county.
The board, run 50/50 by clinicians and lay people, has a budget of £650m in 2013/14.
The budget is significantly less than the PCT’s budget of £965m in 2012/13, but some PCT responsibilities have not been transferred to OCCG.
Dr Richards said OCCG has employed 97 per cent of the staff needed, but said those posts unfilled are not vital for the launch.
He said: “They are administrative posts. All major posts are appointed.”
PEOPLE IN CHARGE OF THE NEW-LOOK NHS OPERATION
THE Oxfordshire Clinical Commission Group (OCCG) board is made up of:
- Ian Busby – chairman: Former civil servant and private equity fund chief executive with 30 years’ experience in public and private sector change initiatives worldwide
- Prof Louise Wallace – lay representative: Patient and public involvement focus. Thirteen years as clinical psychologist, 10 years NHS management experience and professor of psychology and health at Coventry University
- Ros Avery – lay representative: Audit and governance focus. Qualified accountant, former head of finance at Oxfam UK and Ireland and now financial lead for Depaul International, which supports homeless people
- Sula Wiltshire – director of quality and innovation and interim nurse director
- Dr Graz Luzzi – interim secondary care clinician
- Dr Stephen Richards – chief clinical officer: GP in South Oxfordshire for 23 years, now with Goring and Woodcote Medical Practice, and former medical director of Oxfordshire PCT
- Gareth Kenworthy – chief finance officer
- Andrew McHugh – practice manager representative: Former major in British and Omani armies, finance controller of Aga Khan Health Service and now director of Horsefair Surgery in Banbury
- Dr Mary Keenan – medical director: Qualified in Liverpool, spent a year in Southern Africa, constructed GP scheme in North West and partner in Milton-under-Wychwood and Chipping Norton
- Dr Jonathan McWilliam – director of public health: For the last six years joint director of Oxfordshire PCT and Oxfordshire County Council. Also honorary senior clinical lecturer at Oxford University
- John Jackson – director of social & community services: Qualified accountant, worked in local government since 1979 and now director for social & community services at Oxfordshire County Council
- Dr Peter von Eichstorff – clinical director for Oxford City
- Dr Joe McManners – clinical director for Oxford City: GP for seven years following training in Oxford, Sydney, and Liverpool. Principal GP at Manor Surgery, Headington
- Dr Paul Park – clinical director for north: PhD in epidemiology from Cambridge University, academic clinical fellow at Oxford University and now principal GP at Banbury Health Centre
- Dr Stephen Attwood – clinical director for north east: GP principal at Bicester Health Centre for the past 25 years and involved in Bicester Community Hospital project group
- Dr Andrew Burnett – clinical director for south east
- Dr Gavin Bartholomew – clinical director for south west: Experience in hospitals and developing countries, GP for 20 years and now GP at White Horse Medical Practice in Faringdon
- Dr Joe Santos – clinical director for west
- Dr Graz Luzzi – external specialist consultant (secondary care clinician)
- Lorraine Foley – director of commissioning and partnerships