The Sub-Committee is provided with a presentation on and a copy of the strategic case for the alignment of Croydon Health Service NHS Trust (CHS) and Croydon Clinical Commissioning Group (CCG) with a view to informing a discussion on the information contained.
The Sub-Committee considered information provided on both the work to closer align the Croydon Health Service NHS Trust (CHS) and the Croydon Clinical Commissioning Group (CCG) and the integration of the six South West London CCGs into one larger CCG. Together with information set out in the agenda, a presentation was given to the Sub-Committee by representatives from CHS and the CCG. Those in attendance at the meeting for this item were:-
· Agnelo Fernandes – Clinical Chair – Croydon CCG
· Matthew Kershaw – Interim Chief Executive - CHS
· Mike Sexton – Chief Financial Officer – Croydon CCG
A copy of the presentation can be found on here –
Following the presentation the Sub-Committee was given the opportunity to question the representatives on their plans for the closer alignment between CHS and the Croydon CCG and the wider integration of the six South West London CCGs. The first question related to the proposed £500m sub regional saving that had been identified as one of the drivers for the integration of the six CCGs, with it questioned what proportion of this saving would need to be found in Croydon. In response it was confirmed that the targeted saving from Croydon services was £100m as Croydon had approximately 25% of the population of South West London.
It was questioned what difference the changes would make to a member of the public. Regarding the alignment of CHS and the CCG it was advised that by bringing together the health bodies in Croydon it would provide a greater focus on local priorities leading to the delivery of joined up services that were reflective of the needs of the local population. Experience had found that gaps in service provision tended to arise from the hand over between services and it was hoped that closer alignment would reduce such issues.
The move to merge the CCGs on a sub-regional level had in part been prompted by the NHS Long Term Plan which set out the need for integrated care and larger regional CCGs. As it was a national policy it was important to ensure that the best outcomes were delivered from it locally.
As there would be one Accountable Officer responsible for overseeing what was formerly six CCGs, it was questioned how that person would be able to retain line of sight over service provision. It was advised that in order for an integrated care system to work it was important to get the governance processes right, while also retaining a focus on outcomes that made a difference for patients. There would be a Local Committee in Croydon to determine the majority of the commissioning decisions for the area, leaving the Accountable Officer to oversee this process and ensure that promised outcomes were being delivered as expected.
In response to a question about the level of decision making to be retained at a local level following the integration of the South West London CCG it was advised that it was envisioned that the vast majority of decisions effecting Croydon would still be made at a local level. There were safeguards built into the governance structure to ensure sound decision making, which would mean that it was unlikely that there would be a disagreement between the Local Committee and the Accountable Officer. It was important that the Croydon Local Committee was engaged with the South West London CCG in order to build strong relationships.
It was highlighted that all GP practices within the areas covered by the proposed CCG integration would have the opportunity to vote on the move to a South West London CCG. The Croydon based GP surgeries were due to vote on 17 October.
It was confirmed that there would be nine Primary Care Networks (PCN) in the borough each made up of a number of GP practices. A base of 30,000 to 50,000 patients was needed to form a PCN, so it would be possible for a large practice to form its own PCN, with examples of this elsewhere in the country. GPs were given the choice of which practices they wanted to work with to form their PCN.
In response to a question about any potential concerns GPs may have about the proposed integration it was advised that there was a view that health care provision in the borough was currently in a good place so why change it. Also as Croydon was not in deficit when there were funding issues elsewhere in South West London there was concern over how this would affect Croydon. Although reassurance could be taken from it being regulated to ensure that one local area could not pass their funding issues onto other areas within the new regional CCG.
Local Choice remained a standard part of the NHS offer. And the proposals were intended to maximise resources in Croydon to provide better services locally for residents. Patients were able to receive treatment outside of the borough, but if the services in Croydon were high quality and people want to choose to receive their treatment locally.
As the One Croydon Alliance moved forward with expanding its scope to cover all age groups in the borough, it was questioned whether the partners remained aligned. In response it was advised that going forward it would be important to build on the existing partnership work, but as the focus expanded it was essential to ensure that the right representatives were involved. This included ongoing conversations to involve different partners to build on existing strengths.
In response to a question about the expected savings from changes it was advised that one of the key initiatives was to increase the amount of patient care provided within the borough from 70% to 80%, which would increase funding by £10m that would help to support services. Work was also ongoing to reduce referrals, which were down 10% year on year and included on improving on patients having intervention if not needed. If the plan was achieved it would clear the deficit for CHS.
It was confirmed that the decision to discontinue IVF services in the borough was currently being reviewed. The Sub-Committee welcomed this move and looked forward to a further update at a future meeting.
At the conclusion of this item the Chair thanked the representatives from CHS and the CCG for their attendance at the meeting and their engagement with the questions of the Sub-Committee.
At the conclusion of this item the Sub-Committee reached the following conclusions:-
1. The Sub-Committee welcomed the optimism from CHS and the CCG on the future direction of travel, but agreed that the changes would continue to be monitored as they progressed.
2. In the light of concerns raised by the Sub-Committee over the level of decision making that would continue to be taken on a local level through the new South West London CCG structure, it was agreed that this would continue to be monitored.