How does a CCG work? – Blog 23

Thursday, May 30, 2019 - 09:15
Dr Paul Williams, chair of West Norfolk CCG


As I write this it is the end of May and we are all looking forward to the summer. This is a time when we have just finished wrapping up the last financial year and are busy making plans to allow us to continue to offer a high standard of health services in the area for the next 12 months, while also delivering the financial savings demanded of us by our regulator NHS England and Improvement.

In this edition of my blog I thought I would try and explain to you what it is we actually do at the CCG, and how you can learn more about our activities and decision making.

We have received a budget from the NHS of about £293 million for the year 2019/20. That seems a staggering sum yet, when our costs and the money we need to pay to all the providers of care within the CCG area are taken into account, it means that we are going to have to save about £12 million just to break even.

CCG stands for clinical commissioning group. Commissioning is what we call the process of deciding what services we want a provider to do for us, and then agreeing a contract to ensure we get what we pay for. For example we have a contract with Queen Elizabeth Hospital in King’s Lynn to provide urgent and emergency care. That means paying for them to treat you when you go to A&E or get sent in by your GP with an acute illness, such as appendicitis. Within that contract there are targets the hospital have to try and meet, like the famous one about being admitted or discharged within 4 hours when you attend A&E. We monitor the performance of the hospital and every two months we publish a Finance and Performance report which lists exactly how the hospital has performed on all its targets or indicators.

As well as the urgent care contract we also have a contract with the hospital to provide what we call planned care. This is where your GP refers you to outpatients and the hospital decides you need some treatment, for example a new hip. The cost of the procedure is laid out in a tariff published by NHS England, and when the hospital carries it out, it is paid that cost. This means the more elective work it does the more it gets paid. Again there are targets the hospital has to meet in this area, and these are also included in the Finance and Performance report I mentioned earlier.

Another measure we have of the hospital’s performance is the Delayed Transfers of Care (DTOCS) statistics. These are the numbers of people who are medically fit for discharge but have not been discharged because there is nowhere for them to go in the community: what you may have heard described in the press as ‘bed blockers’. We monitor these figures and try to get them as low as possible. We can influence these figures through other contracts we have with community providers and social services. For example we pay Norfolk Community Health and Care (NCHC) to provide a service called the virtual ward: this is a team of nurses who can intensively nurse you at home for a few days after you are discharged. We also pay Norfolk County Council for a service called Norfolk First Support: these are social carers who help with the social aspects of the extra care needed in the first few days after you’re discharged from hospital. We also pay for what we call intermediate care beds. These could be in a nursing home or cottage hospital, and are beds out of hospital for people well enough to be discharged but still too ill to be cared for at home.

Every two months we have a Governing Body meeting in public where, among other things, we discuss the performance of all our providers. Sadly very few members of the public come to these meetings which are usually held at the West Norfolk Deaf Association building in Railway Road in King’s Lynn.

Our next meeting in public is in fact our Annual General Meeting where we will be distributing our annual report and reviewing our performance in the last year. We will also be following the AGM with a full Governing Body meeting where the latest performance figures will be discussed.  The AGM will be held on the morning of 1 August at King’s Lynn Town Hall.

See you there?