As Health Secretary Andrew Lansley loses his job over his handling of the Coalition Government’s deeply controversial NHS reforms and with doctors in North Yorkshire telling us the NHS is “living beyond its means” we take a look at the state of the service and explain what you can expect, and not expect, from the it in the future.

UNLESS you have been out of the country on a very long holiday, it’s unlikely you have failed to notice there’s something going on with the NHS.

The reforms, as they have become known, have been in the headlines ever since the Coalition came to power, with talk of things like clinical commissioning groups, self-care and framework indicators.

All very confusing but, and not overstating the matter, the changes to the way your healthcare will be provided are probably the biggest reform of the health service in its history.

But what exactly is going on? The NHS is a cumbersome beast with several levels and offshoots, all making it very hard to understand the changes which are now under way.

In July 2010, the then Coalition Government’s Health Secretary, Andrew Lansley, announced major plans to scrap Primary Care Trusts (PCT) and replace them with new, smaller organisations led by local GPs and other healthcare professionals.

PCTs, which in this area is NHS North Yorkshire and York , are currently responsible for selecting and buying all NHS services you might currently access – ranging from those offered in GP practices and dentists to hospital-based procedures and operations.

The PCT is essentially given a lot of money from the Department of Health to spend on your healthcare They also have a responsibility for health promotion and trying to deter us from doing things that can damage our health such as smoking, drinking too much alcohol or eating too many burgers.

In the new world, these responsibilities and all that government cash will be shared among a number of different organisations; some existing and some completely new.

Clinical Commissioning Groups (CCGs) will take the lion’s share and will be responsible for managing significant budgets to pay for local health services on behalf of their population.

Currently operating in shadow form alongside the PCT, they will take the commissioning reigns from April next year but with one major headache – the outgoing PCT will leave behind a £19million deficit in our region which the commissioning groups must find a way to claw back. And with North Yorkshire’s population getting older and living longer, it is a major challenge.

As chief clinical officer of the new NHS Vale of York CCG, Dr Mark Hayes will be one of those with the unenviable task of working out how to balance the books while making sure we get access to good healthcare.

Quoting Walt Disney, he said it was “kind of fun to do the impossible”.

He said: “The new CCGs in North Yorkshire have the seemingly impossible task of improving the quality of local healthcare at the same time as balancing the books. The healthcare system in North Yorkshire has been living beyond its means for at least ten years.

“We are currently grappling with an estimated deficit of £19 million in North Yorkshire and, unless major savings are found by April 2013, this could be very much more.

“So the new CCGs will have a difficult birth and we will be handicapped by the debt from this year being removed from our allocation of funds next year. Without substantial change this year’s deficit will double to £38 million next year.

“So why have the GPs in North Yorkshire got involved? Firstly, because within this crisis there is a golden opportunity to make a real difference to the lives of North Yorkshire residents by improving the healthcare system. Secondly, we feel that clinicians have a unique perspective to bring to the discussions on the utilisation of scarce resources.

“The CCGs believe that this financial problem can only be solved by the active participation of all those involved in delivering healthcare to North Yorkshire. We are already working very closely with the hospitals, local government and the voluntary sector to come up with new ways of delivering the care that is needed by the people of North Yorkshire.

“We know that the financial issues, which have existed for the last ten years, will not be solved overnight but we are confident that over the next two-to-three years we will create a new, better, high-quality healthcare system that operates within its financial budget.

“In finishing I will quote from Helen Keller, ‘optimism is the faith that leads to achievement’.”

 

The role of Clinical Commissioning Groups (CCGs)

CCGs are the key players in terms of commissioning (buying) the vast majority of healthcare services you may require from a range of different providers (such as York Hospital ). These services include:

• Planned hospital care, eg a hip replacement

• Urgent and emergency care, eg resulting from a traffic accident

• Rehabilitation care, eg to help recover from a stroke

• Community health services, eg District Nursing Teams

• Mental health and learning disability services.

CCGs are made up of a number of member GP practices and have responsibility for smaller areas than the former PCT. North Yorkshire and York is being split into five new CCG areas:

• NHS Vale of York CCG

• NHS Harrogate and Rural District CCG

• NHS Hambleton, Richmondshire and Whitby CCG

• NHS Scarborough and Rydale CCG.

Which CCG you belong to depends on which GP practice you are registered with.

So, for example, if you are registered with Haxby Practice, you fall within NHS Vale of York CCG, but if you are registered with Derwent Surgery in Malton , you will receive services commissioned by NHS Scarborough and Ryedale CCG.

Each CCG is likely to have some variation in the services they commission.

NHS Vale of York CCG represents 36 GP practices spread over York, Selby , Tadcaster , Easingwold, Ryedale and Pocklington.

It has an annual budget of about £340million to commission services for a population of around 340,000 people.

Led by Tadcaster GP Dr Mark Hayes along with a number of other local GPs, the CCG is already making good progress in terms of developing as an organisation and identifying the health priorities for the area.

Involving the public as much as possible in its decision making is very much at the forefront the CCGs mind, and they have already made progress with this by holding two public events and establishing a patient user group.