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Editorial Thursday 10 November 2011: Andrew Lansley speech to NAPC conference

Text of Health Secretary Andrew Lansley's speech to the National Association of Primary Care (NAPC) Annual Conference, November 2, 2011


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Thank you. It is always a pleasure to be here at the NAPC. To be in the company of future leaders – and increasingly the present leaders – of the NHS.

A lot has changed since I attended this conference last year. But more important are the things that haven’t changed. Your enthusiasm for taking on the opportunity and responsibility for making sure that your patients get the best possible care has not wavered.

And my commitment to seeing you – the frontline clinicians in the NHS – take on that responsibility and use those resources remains as firm as ever.

The work you have all achieved over this past year to make that a reality has been exceptional.

Last year, the pathfinder programme had just started. Today, there are 266 pathfinder clinical commissioning groups covering virtually the whole country.

Last year, Health and Wellbeing Boards remained a concept on paper. Today, in 132 councils covering most of England, they are a reality.

And I am delighted to announce today that, subject to passage of the Health and Social Care Bill, we have reached agreement with the BMA that under the GP contract, all practices in England will be members of Clinical Commissioning Groups.

That is progress that has been led by you. And it is progress that I know you will continue to lead. The purpose of this journey has always been clear.

First, clinical commissioning groups will have the freedoms – the legally-backed freedoms – to plan and shape health services which best meet the needs of your patients, without interference from politicians, and without day-to-day instructions from the centre.

Second, clinical commissioning groups will have the freedom – again, the legal freedom – to choose who should support you in taking charge of local health services. Clinical senates and clinical networks will be on hand to advise you – not to tell you what to do – there to support you and work with you.

And third, clinical commissioning groups will have the freedoms to structure yourselves to meet the needs of your local populations, provided you involve patients and members of the public, with nurse and secondary care experience.

Already, we are seeing how your use of these developing freedoms can transform the quality of people’s lives.

Like in Surrey, where ESyDoc GPs have worked with their colleagues at the local NHS Trust, Ambulance services, out-of hours providers, community teams and patients to improve care for people with COPD. The result?  A halving of the number of hospital bed days.

Or in Torbay, where they have enhanced the role of the discharge co-ordinator across health and social care. The result?  The average length of stay in hospital has been cut by more than 10%, freeing up nurses to spend more time on patient care.

Or in Yorkshire and Humber, where the Ambulance Service provides a monthly list of their top 10 most frequent callers. Those on the list are then given intensive, personalised help from a wide range of clinicians, community and social care professionals, including the use of modern telemedicine to monitor their vital signs.

The result is better care for patients as well as – for this group:

a 70% fall in A&E attendances,

a 60% fall in unplanned admissions,

a 20% reduction in bed days

and a halving of ambulance journeys.

All in all, much better care for individual patients and a more effective use of people’s talents and NHS resources.

With these freedoms come responsibilities.

First, as members of clinical commissioning groups, you have a responsibility to the public and your patients to make sure that your patients have access to the NHS services they need.  That – in law – is what is described as the ‘comprehensive health service’. It is the same duty that has been placed upon me and all my predecessors as Secretaries of State for over 60 years, and it will be incumbent on you to discharge that duty in the future as it will remain incumbent on me and my successors.

Second, as members of clinical commissioning groups, you have a responsibility to the public, as taxpayers, to make sure that every pound of NHS money is spent as effectively as possible to deliver the best possible care. I know many of you will see – every day – examples of waste in the NHS.  As members of clinical commissioning groups, you will not only have the opportunity, but the responsibility, to make sure that every penny is spent in the interests of patients.

And third, as clinicians and members of clinical commissioning groups, you have a responsibility to deliver better outcomes for your patients.  There should be no conflict of interest.  There is one consistent objective – developing services locally so you can deliver the right services individually for your patient.

And the essential purpose for us all, the continuous improvement of outcomes for patients.  Last year, we published in draft the NHS Outcomes Framework. It set out the five areas in which we want the NHS to achieve improvement:

Preventing people dying prematurely

Enhancing the quality of life for people with long-term conditions

Helping people to recover from episodes of ill-health or following injury

Ensuring that people have a positive experience of care

Treating and caring for people in a safe environment and protecting them from avoidable harm

Later this year, we will publish the final NHS Outcomes Framework, against which the NHS Commissioning Board and you – as members of CCGs and through the Commissioning Outcomes Framework – will be held to account.

A framework, not of process targets, but of clear, measurable improvements in the standards of care for your patients.

In general practice, you already have a direct influence on the outcomes you achieve for your patients receive. But as leaders of the local NHS – and as members of clinical commissioning groups – you will have an even greater influence.

You will be guided in your decision-making by clear, national commissioning guidance. You will be helped in your work with providers through clear, national standard contracts and through evidence-based quality standards and quality indicators.

You will have additional tools to use, including tariffs, which will increasingly support quality and best practice, including the ability to commission. And with your focus on population health, together with health and wellbeing boards, you will be able to develop stronger preventative services and impact on the social determinants of health.

So the purpose of this journey, there are clear objectives, clear freedoms and three clear responsibilities for clinical commissioning groups. And I know that you want to get there as soon as you can.  That is why I want to be clear about the support you have now, and the support you will have in the future, to make the progress which you want to see.

First, clinical commissioning groups will have support for running costs of between £25 and £35 per head. If you can demonstrate that you can live within that running cost allowance with good financial governance, then we will not stand in the way of how you want to structure yourself, or the size you wish to be.

Second, you will be free to employ who you want to in the structure which you feel is right for you. To help you, we have published a ‘ready reckoner’ to guide your decisions, but it is not a rule and it is not definitive.

Third, we know that you will need support for the things that require more than clinical leadership. Because I know that you’re not accountancy experts, contracting specialists, media managers, estates managers or HR professionals.  And you know that expertise of this kind can be found amongst the people who currently work in PCTs.

That is why we need to get commissioning support right.

Over the coming months, you will need to work together with your colleagues in PCTs to understand what support you will need and ensure that the offers that they create will help you through authorisation and beyond.

You will want to directly employ some staff to work in some areas.
In other areas, you will want to work with neighbouring clinical commissioning groups to share commissioning support across your boundaries in others.

You will want to work closely with local authorities to deliver big step-changes in the quality of preventative care, in public health and in commissioning integrated services, such as for mental health, care of the elderly and community equipment.

You will want to explore relationships with the independent and voluntary sectors to bring a fresh perspective to the challenges we face of improving outcomes for your population.

From April 2013, you will have the legal freedom to work with whoever you want, however you want. But between now and then, PCTs and SHAs should support you in delivering on your vision.  But you also have the responsibility to ensure that you retain the best staff to do the best possible job for patients, whether they work directly for you within a CCG or as part of an external commissioning support service.

You will need them. And the NHS will need them.

That is why I want you to build on the relationships you have with your colleagues in PCTs already, and to work with them in understanding how best to grow these relationships into strong, lasting and effective partnerships which will help the NHS of the future.

We want all the people supporting you in commissioning in the future to be members of sustainable, independent and viable organisations – and viable means being:

customer focussed,

technically skilled,

able to cover costs by delivering services at the right scale,

and being flexible enough to fully meet your needs.

That is why over the past few months, we’ve been working with you, with your colleagues in PCTs and with others to map out the best way forward. A way which ensures the best staff in PCTs are retained for the future in a way which best suits the needs of the communities you serve.

And today, we are sharing, in draft, guidance on commissioning support.

The guidance is intended to help you understand how best to get the help you need to deliver truly effective, clinically-led commissioning.

This guidance recognises that some support services may be done in-house, others bought in by the CCG, others still, shared across a number of Clinical Commissioning Groups.

It reflects the discussions and feedback we have had to date – but it’s not the finished article.  We hope to publish final guidance before the end of the year.

We need your feedback and your ideas so we can get this guidance right.  Some parts you might like, other parts you might not.

That is why I want the Clinical Commissioning Coalition to work with the new Business Development Unit in the Commissioning Board to help get commissioning support right.

We’re all improving as we go along.  This is and will continue to be an organic process of development and it will be far stronger as a result.

Leadership Framework
And as well as the guidance, we’re working hard to make the task of commissioning about value added.  One way of doing this is through the new Leadership Development Support Framework.

Strong leadership is going to be essential at every level as we move forward.  And we need to support our current and future leaders as much as we can.

To help with this, the NHS Leadership Academy has this week launched a national framework of leadership development support for emergent Clinical Commissioning Groups.

The Framework is a range of high calibre organisations with a proven track record that have been selected by clinicians to be on the framework.

And because they are quality assured, all you have to do is to determine your development needs and run a simple selection process to get what you need.

Clinical Commissioning Groups will also be able to access funding support in the form of a bursary from the National Leadership Academy.

The NAPC has been at the vanguard of developing clinically-led commissioning, and I know will continue to be.

Clinically-led commissioning is about ensuring that the decisions you make as clinicians about the care of patients, and the commissioning decisions are consistent and effective.  So we will support you.

To design the services you know your patients need.

To do your job as a clinical commissioning group in the way you want to do it.

But with those freedoms come responsibilities.

The responsibility to deliver comprehensive NHS services to your patients.

The responsibility to ensure every penny of taxpayers’ money is spent wisely.

The responsibility to secure the best commissioning expertise, including retaining the best staff within PCTs.

And the greatest responsibility of them all – to deliver better outcomes for your patients.

This will require leadership.

You are all very much the masters of your own destinies.

It will be you who decide the number of practices in your Clinical Commissioning Group.

It will be you who decide the size of the population you cover.

It will be you who decides your best way forward towards authorisation.

(Not even the Commissioning Board.)

Not PCT Clusters.


I know because I have met many pathfinder groups that are showing the vision, practical approach, clinical focus, creating partnerships and developing the strategies which will deliver for their patients.

And as you do that you will find that the government, and the new system, will support you every step of the way.

Thank you.