What effect will the establishment of CCGs have on practice IT and informatics? It will all depend upon the way your CCG is run.
Personally, I classify CCGs into two types. Class 1 has general practice at its heart. Everyone (including CCG staff) accepts that the practices 'own' the CCG and are responsible for directing and running it. (This is the original vision for CCGs under the government’s proposals.)
By comparison, and completely against the spirit of the new changes, Class 2 CCGs aren’t 'owned' by local practices. Either the CCG perceives itself to be in control of its practices (much as the worst of the old PCTs were); or alternatively the CCG is being subtly disempowered by other NHS organisations — for example external commissioning support services, the regional divisions of the NHS Commissioning Board, and so on.
Why is this important for practice IT? Crucially, the way your CCG functions will determine how empowered practices and clinicians will be in terms of the selection and deployment of the IT their CCG supports, and the data it requests. Clinicians need to be highly influential in the way IM&T develops within their CCG.
IT clinical leads
Ideally, each CCG should have a chief clinical information officer (CCIO) on its board – or at the very least a clinical lead for informatics.
The job of these clinical informaticians is to ensure that IT is utilised wisely, and that essential data is collected appropriately, analysed sensitively and used ethically.
They will also be responsible for ensuring that information is used effectively, to encourage good practice, set up efficient treatment pathways, inform and refine the commissioning process, and identify poor performers in both secondary and primary care.
Most importantly, the CCG’s clinical informatician should also strangle at source all requests for irrelevant or inconsequential data collection.
Clinical IT leadership in the CCG is vital if the CCG is to work efficiently for the benefit of the patients. With clinical informaticians in place, practices will know that their time spent gathering data for the CCG will be time used effectively. Indeed, Class 1 CCGs will be in the forefront of CCG efficiency and cost-effectiveness. They will be the ones that can really deliver quality health care for a minimal amount of fuss.
I’m fortunate: I practise in an area with an excellent Class 1 CCG: we also have a particularly effective LMC. Sadly, many colleagues in other geographical areas look as though they are going to be saddled with Class 2 CCGs, which is in no one's interest apart from the managers.
Influencing your CCG
If you think your CCG is turning into a Class 2 variety, then what can you do about it? Most importantly, make yourself heard. Recognise that bringing the CCG under the full control of its constituent practices will be of great importance in the future.
Don't sign up to your CCG’s constitution until you are sure that the CCG is under GP control and not the other way round; and use your LMC to lobby on your behalf if needed.
Even if you are fortunate enough to have a Class 1 CCG, this doesn’t mean that external agencies can’t exert a deleterious effect by trying to pull strings remotely. So the next action is strongly to resist any attempts by outside bodies to interfere with the functioning of your CCG, or even to take over large parts of them.
There are any number of external NHS organisations that would dearly like to control their related CCGs from afar: unfortunately, all this will do is force them into the same inefficient, top-down organisational structure that we had before the new reforms.
Finally, lobby your CCG to appoint either a chief clinical information officer, or at the very least a clinical lead for informatics. Your CCG, your practice, and your patients will be far better served by this arrangement.
- Dr John Lockley is a GP in Ampthill, Bedfordshire; clinical lead for informatics at Bedfordshire CCG; and a member of the board of Bedfordshire and Hertfordshire LMC Ltd. This is the first article in a series about how CCGs will impact on practice IT.