New legislation which came into force on 1 April 2013 has changed the structure of the NHS in England beyond all recognition, and has brought with it a raft of new organisations which are now involved in the delivery of health services. The responsibilities of some existing bodies have also been redefined. Here is an overview of some of the most important changes:
National Health Service Clinical Commissioning Board (NHS CB)
The NHS CB is a new independent body; although it will be closely linked to the Department of Health. Its role includes overseeing the commissioning budget, and authorising and funding CCGs, which are responsible for commissioning local healthcare services. The NHS CB will retain some direct commissioning responsibilities, however, such as urgent GP care, pharmaceutical, dental and optical services; together with public health services for members of the armed forces, and people in prison.
Clinical Commissioning Groups (CCGS)
CCGs primarily comprise local GPs and are responsible for commissioning local healthcare services. They are also responsible for commissioning many hospital, community health and mental health services. The intention is that CCGs will use their local knowledge to commission services. CCGs will be responsible for spending £65 billion of the £95 billion NHS commissioning budget.
Health and Wellbeing Boards
Each local authority will have a Health and Wellbeing Board. Members of the Board will include elected representatives, as well as clinicians and representatives of the local authority with responsibility for social care, together with a local Healthwatch representative. The Board is designed to provide support and strategic advice to the NHS CB, CCGs and the Local Authority in order to ensure that the commissioning being carried out by these organisations is meeting local needs. Health and Wellbeing Boards will also be responsible for Pharmaceutical Needs Assessments.
Public Health England (PHE)
PHE is a new executive agency of the Department of Health. Its remit is to work with local government and the NHS in order to improve the nation's health. PHE will also provide support and information to the NHS and Local Authorities and other bodies in order to respond to public health emergencies.
Will continue to be responsible for providing social care. They now have an additional obligation to protect and improve health and wellbeing. As such they will commission "enhanced" services such as drug and alcohol misuse services. They can commission these services from suitable providers, not only pharmacists.
Local Healthwatch and Healthwatch England
Healthwatch is a new "consumer champion" for both health and social care. Local Healthwatch are independent bodies which will have a seat on the local Health and Wellbeing Board, in order to ensure that the views and experiences of patients are considered when local strategies are produced. Local concerns will be reported back to Healthwatch England which forms part of the Care Quality Commission (CQC).
There will be 12 clinical senates in England which will be "hosted" by the NHS CB. They are designed to provide expert clinical knowledge and leadership to the NHSCB, CCGs and Health and Wellbeing Boards in order to assist them in commissioning decisions.
Local Professional Networks
Are small teams of clinicians who will support the NHS CB in its commissioning role. They will advise on specific areas of commissioning, such as pharmacy services. It is also intended that they will develop relationships with other bodies responsible for commissioning; such as CCGs, the Health and Wellbeing Board and LETBs (local education and training boards), and will engage with other local representative bodies, such as LPCs.
Monitor is now responsible for ensuring that NHS services are effective and offer value for money. One of the ways in which it will do this is to license healthcare providers, probably in conjunction with the CQC. Monitor has to make sure that commissioning is done in a way that is transparent and avoids conflicts of interest. As pharmacists are not currently regulated by the CQC it is likely that they will not fall within Monitor's remit, initially.
Care Quality Commission (CQC)
Since 2012 the CQC has been responsible for regulating dentists, and from 1 April 2013 it is responsible for regulating GPs. The CQC does not, currently, have any responsibility for regulating pharmacists. However, as the independent regulator of health and social care for England, it is likely that the CQC's remit will extend to pharmacy in time. The large number of new bodies with new, and in places seemingly overlapping, responsibilities, is likely to lead to a period of uncertainty and confusion for those commissioning and providing health services. There may also be a lack of consistency in commissioning decisions; particularly from organisations who have not commissioned health services previously, so anyone tendering to provide services, or unsuccessful bidders, may need to seek specialist advice.
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