Heaton & Tame Valley Consultation Event

Closed 28 Mar 2012

Opened 27 Mar 2012

Feedback updated 10 Jul 2012

We asked

What do you think about our plans?

You said

Too many acronyms in the detailed plan which was handed out as additional information.

We did

We've published a list of the acronyms in the detailed plan and will ensure that all future public documents are in plain English.

Results updated 28 May 2012

20 local residents attended the event at the Rudyard Hotel.

Audience Photo

Tim Ryley, Associate Director for Strategy & Governance, gave a presentation on the plans for Stockport's Clinical Commissioning Group and its focus over the next three years.

Tim Giving Presentation

A number of questions were raised about what the CCG will do and how it will work:

What sort of decisions will the CCG make?

Like the Primary Care Trust now, the CCG will be responsible for the local NHS budget. They will decide what health services local people need and write contracts for local clinics and hospital to deliver them. They will then contract manage local service providers like the local hospital and make sure they are delivering all the services local people need in the right way.

What experience do the most doctors have about managing a hospital?

The GPs running the CCG have all worked as doctors in a hospital as part of their training. Most importantly, they are all Stockport GPs, so they see local patients every day. Not only to they diagnose their health needs, but they also get to hear what experience they have had when referred to local services. Their role is not to manage the hospital, but to decide what health needs there are locally and to budget for local hospitals to provide those services.

Want clarity about the Clinical Director / Accountable Officer roles.

Dr Ranjit Gill has been elected by the GPs in Stockport to be their Accountable Officer. This means that he takes overall responsibility for all decisions of the CCG – much like a Chief Executive. He will do this job three days a week and continue to work as a local GP 2 days a week.

Three Clinical Directors were also elected by their GP Colleagues:

  • Dr Ash Patel will take responsibility for contracting services, quality assurance, effective use of resources, and monitoring performance of local healthcare providers;
  • Dr Jaweeda Idoo will take responsibility for major service transformation, long-term conditions, and reform of unscheduled care;
  • Dr Cath Briggs will take responsibility for member relations – working with GP Practices to manage prescribing and referrals, to share best practice, and to develop patient reference groups.

How can a doctor from a general practice persuade us that he has got the backbone to handle £480m?  Is it a paid position and what sort of salary will he be getting?

Yes, this is a paid position, but the salary has not yet been agreed. The PCT Chief Executive received the same salary as a GP.

Stockport’s GPs have been involved in the commissioning process, including the financial aspects of commissioning, for a number of years now. On top of that, GP Practices are all independent business, which have their own financial responsibilities. Clearly, there will be a steep learning curve as we start to take on the management of the full health economy, but over the next year we are in a period of transition where we have the safety net of working alongside the existing PCT. And GPs don’t assume they know it all – we have a Director of Finance working for us, who must be appointed nationally.

Will the Medical Consultant have to be from outside of Stockport and will it be a doctor?

Yes. This role on the governing body has been decided by the national rules. The NHS wants each Governing Body to have independent voices, representing Medical Consultants (e.g. a doctor working in a hospital) and Nurses. But they must come from another area, so that there is no conflict of interest – it would be unfair to have a Surgeon from Stepping Hill on the board that decides how much we pay Stepping Hill hospital...

What about other healthcare providers? (e.g. District Nurses, Opticians...) Where will they fit in the process?

The CCG’s Constitution sets out how the whole range of healthcare professionals will be involved in decision making.

If we had a representative from each profession, the meeting would be too big to take any decisions. Instead, local healthcare professionals will be involved in detailed service re-design and clinical pathway specifications in their area. The Governing Body will take the high level decisions, but they will ask local groups of experts to go away and work up the details. This is where the other healthcare professionals will have their say and ensure that decisions are right for patients.

What are the timeframes for the CCG to be fully staffed?

From April this year, the CCG exists in shadow form, working alongside the PCT and its staff.  We hope to be fully staffed and authorised by the end of 2012 and ready to go live by April 2013, when PCTs will be abolished..

Does Mental Health come under GPs?

GPs will continue to prescribe medication and refer patients. The Clinical Commissioning Group will be responsible for contracting mental health services to meet local needs. However, specialist mental health work - Broadmoor for example -will be done at a national level by the NHS’s new National Commissioning Board.

How much is set aside for specialist commissioning?

Previously, the Primary Care Trust had a budget of around £480million a year.

From April 2013, CCGs will have a budget of £370million.

The difference will go to other organisations due to changes in the NHS structures:

  • £25 - £30m will go to the Local Authority who will take over responsibility for public health.
  • £40 - £50m will go to the National Commissioning Board to manage GP, Pharmacist, Dentist, and Optometry Contracts.
  • And a further £25 – £30m will go to the NCB for commissioning specialist services in Stockport.

On specialist commissioning – for certain services you have to go through a process in the PCT to decide whether or not you can be referred for treatment.  Will this be the same in the CCG? 

These are two separate things:

  • Specialist Commissioning is for things like brain surgery, where you are only likely to see one of two cases a year in Stockport. We need the service, but we cannot predict how many cases there will be in a year. So these services are designed and commissioned nationally, or by working together in a specific area, like the Christie Cancer services which cover a range of local PCTs. This will move to the National Commissioning Board.
  • Locally, the PCT sets policies on what medication or treatments it thinks we should and should not use – based on clinical research. However, we know that everyone is different and that general rules will not always be right for a particular patient. If a patient or their GP thinks that a treatment, which the PCT has not agreed, would benefit an individual patient, they can make anIndividual Funding Request (IFR) which goes to a panel of clinicians to hear the individual case and decide what is the best option for that patient. The CCG will continue to use the IFR process to make sure the best decision is always taken for individual patients.

How will the budget be audited, monthly, quarterly?  How will it be provided to the Governing Body?

It will be the responsibility of the National Commissioning Board (NCB) to look at each CCG and assess it to see if it is on track. However, the CCG’s Governing Body will want to ensure that it is on track. It will receive a monthly progress report from Finance to check progress and address any issues that may arise. As the Governing Body is a public meeting, the finance paper will be available on our website every month under the Governing Body papers.

It was noted that the NHS uses far too many acronyms.

We will make up a glossary for any handouts and try in future to cut out the acronyms.

To develop personal responsibility for health – is this a CCG thing?

The Government has decided that from April 2013 public health (the preventative side of healthcare, like cancer screening and advice on keeping healthy) should be run by Local Authorities. Stockport PCT’s Public Health team will move to the Council by April 2013. However, the CCG feels that it still has a key role to play in making sure people to stay well. As GPs they will be interested to make sure that people attend screening to catch early signs of disease, to get vaccinated for preventable diseases, and they will continue to offer their patients advice on how to stay healthy.

To help achieve this, the CCG will employ a Public Health Consultant from the Council to sit on the Governing Body. The CCG also has places on the Health and Wellbeing Board will make sure that our work compliments that of the Council.

“An ounce of prevention is a pound of cure.  Health and Social Care should be under one umbrella.”

Will there be tensions?

We will work together to make a real difference – which is vital in a number of areas. The Council’s screening programmes need GP Practices to send out invitations, to perform checks and to give vaccines. Similarly, we can work in healthcare to get more people taking up alcohol interventions, but if the Council change licensing rules, that could have a major impact. And we are working with the local hospital to speed up discharges and reduce costs, but if there is no social care provision available for vulnerable people when they come out of hospital, this will not happen.

There is a lot of work to be done, but in Stockport we are doing it together so that everyone benefits.

How will the CCG influence how long a patient stays in hospital before they are discharged?

As the commissioners, our main level for change is how we use the contract. We have a contract for £140m with Stepping Hill Hospital and £20m with Central Manchester and South Manchester. In that contract, we state what targets we expect them to meet – for example the national target of seeing all patients at A&E within 4 hours. We pay £60 for each person who goes to A&E. But if a patient waits longer than 4 hours to be treated by A&E, the hospital can be fined 50%.

In our hospital contracts this year, we have also put in an incentive for them to work 24/7 – so if there are consultants available 24 hours a day, 7 days a week, and this improves patient outcomes at weekends in particular, they will get extra funding.

There will also be a huge investment in Dementia services this year. If the hospital meet these new targets, they will earn an extra £600k.

Will GPs be given more resources?

No. The GPs will receive the same amount of funding as the PCT, minus the money allocated to Public Health, Specialist Commissioning and Primary care contracts, which they will not be responsible for.

In addition, the Government has been very clear that the amount of money used by CCGs for funding management costs (e.g. staff and buildings etc) will be fixed at £25 per head of population – this is around what Stockport PCT currently spends, but it is a lot less than the management costs of other PCTs in Greater Manchester.

The CCG is looking at how we can change ways of working to deliver the care people need within the limited budget.

How can you influence which A & E an emergency goes to?

In a genuine emergency, patients are taken to the nearest A&E department with the capacity – and, depending on the illness, the expertise – to treat them. Hospitals are paid on a tariff basis by the PCT – or CCG from next year – where the patient is registered. You have to use the contract to hope people get a good standard of care. 

Nothing in the plans talks about choice – I just had my statins changed and got a letter - no respect, no honesty.

Over the past year, Stockport has done a lot of work on medical prescribing to reduce the amount of waste in the NHS. We want people to get the right treatment for them, but as public servants we have to remember that we are using tax payers’ money – and we have to give them the best value too. So where there is a choice of two drugs - one ‘branded’ and one generic – we look at the medical research and see which offers the best clinical outcomes. Where they are the same, we want people to use the generic brand, which can be ten times cheaper, so that we can use the savings to pay for more nurses and more cancer treatments.

In this individual case, there is an issue of respect – ideally, the GP would call the patient in to discuss the change and explain why it is happening.

In some cases – such as epilepsy medication – there will not be any changes because this could have a major destabilising effect on the patient.

In all cases, if you feel there is a valid reason why a change in medication is not right for you, you can contact the CCG and make an Individual Funding request, so that a panel of clinicians can check this is the right change for you.

What is the CCG doing about C-Difficile? Having had pneumonia I was given broad spectrum antibiotics at Stepping Hill and got C-Diff as a result.

C-Diff is one of the key priorities GPs have highlighted in Stockport. C-Diff is a bacteria of the gut which can cause severe illness and even death. Normally the bacteria is kept under control by your stomach acids, but high use of antibiotics and prescribed antacids can cause an outbreak of C-Difficile.

At Stepping Hill Hospital they have seen real improvements by tightening up their procedures on who can prescribe broad spectrum antibiotics. The CCG is working with GPs to have the difficult conversation with patients about not taking antibiotics.

We are also doing a lot of communications work to let people know about C-Diff and how to prevent it.



Public Consultation Event in the Heatons & Tame Valley

Tuesday 27 March 2012

The Rudyard Hotel


Event Poster

What happens next

Your views will be used to help decide the future of Stockport's local NHS.


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