The Plumbers have all the Power
I’m a great one for taking a metaphor and running with it, sometimes to the point where it loses any useful meaning, so please bear with me on this one. Thanks to Andy Cowper of Health Policy Insight for his excellent post “The re-plumbing of Power” in which he is inspired by his domestic refurbishments to explore how the Nicholson Commissioning Board (copyright A Cowper) will aim to control the NHS finances over the coming challenging period, not least through the NCB’s oversight of the Commissioning Support Services (CSSs).
It was during the Watergate scandal that Richard Nixon, a control-freak to warm the cockles of Sir David’s heart, sent in a Special Investigations Unit to bug the Democratic Party HQ in the Watergate Building. The were known as the White House Plumbers. The NCB won’t need to resort to anything so secretive – a simple command and control mechanism involving a very tight grip on the work of the CSSs should ensure that they keep a similarly close control on the work of the Clinical Commissioning Groups (CCGs). Andy rightly notes “concerns are developing that CSS may become ‘eyes and ears’ of the Nicholson Commissioning Board”
This is hardly a surprise but what Andy correctly goes on to do is make the connection between the NCB controlling the CSSs and the NCB also controlling the contracts for all of primary care. I can’t think of a suitable plumbing analogy at this point but these are the rock and the hard place between which the CCGs may be existing for the next 3 or 4 years.
CCGs will need to ensure that the performance of their member practices as prescribers and referrers does not give cause for concern and also that they treat the major variations in the quality of primary care provision as robustedly as they wish to address the variations in secondary care. Otherwise they may well have the tap turned off.