Islington Keep Our NHS Public open letter to GPs
15 November, 2019
Open letter to GPs, from the campaigning group, Islington Keep Our NHS Public, on the Islington Clinical Commissioning Group / merger with others
• I AM writing to you on behalf of local campaigners for the NHS in your capacity as partners in one of the member practices of Islington Clinical Commissioning Group.
We are asking you to consider voting against the constitutional change that is about to be put to you by the CCG, the effect of which will be to abolish Islington CCG with statutory powers to commission health services in Islington, and to create a new combined CCG with the other CCGs in North Central London. (We note in passing that the CCG has already applied to and been accepted by NHS England to merge with the other four CCGs in North Central London. We find it surprising that your permission as the members of the CCG was not sought in advance and the CCG is now having to retro-fit a constitutional change).
Our members are patients in most Islington practices and we wanted you to be able to take note of our views. We were against the compulsory tendering at the heart of the 2012 Health and Social Care Act, but there were positive elements to that act, most notably that commissioning would be done on a very local basis and with the involvement of GPs.
Over the last five or six years there has been constant pressure from NHS England to recentralise decision-making and remove it from locality or “place”. We hope you will resist this change in the constitution of Islington CCG and help to preserve local identity in health decisions.
The chair and board of Islington CCG may say that the change is inevitable, and they are under heavy pressure from NHS England to comply, but this change is in your hands as the member practices and you could over-ride their decision if you chose, since you cannot be forced to give up your statutory duties other than by a change in the law.
We believe that it would be right to resist this pressure for the following reasons.
Partnership with other public services in the same locality is a good thing, but this change takes the focus away from that and will provide more top-down direction rather than respect local relationships.
The key partnership in health is with patients and the public. This change means a serious weakening of public accountability for health commissioning.
Once key decisions are made on a larger “five-borough” scale, there will be more temptation to centralise service provision in order to make (notional) savings, with impact on patient outcomes including increasing health inequality. Little by way of administrative cost will be saved as the CCG already shares many top management posts with the other CCGs.
We think the cost of staying close to the point of health delivery in your practice and in your locality is worth every penny. Most savings from moving to a larger scale turn out to be illusory.
You may be interested to know that the leader of Islington Council, Cllr Richard Watts, agrees that the merger should not go ahead. He has written to NHS England to oppose the change.
In an email to senior staff of North London Partners, which has been passed to us, he said: “I regret I am unable to proactively endorse or support the merger. I remain concerned that the strength and pace of our local integration developments could be hindered by the merger, with the diversion of resources and attention to focus on restructuring, and would want to see a far stronger sense of co-production and co-design of borough-facing ICP (integrated care provider) arrangements with local government, as well as with residents and patients.
“I also have concerns that mental health commissions and ‘prevention’ being seen as strategic commissioning issues would move us away from a community response to these critical issues and towards an expensive medicalised pathway that doesn’t properly address the wider determinants and true prevention.”
We, your patients, know how busy you are and we realise that being the link person to the CCG is only one of your many duties but we very much hope that you will not just nod this change through but discuss it seriously with your partners and colleagues before making a considered decision.
PROF SUE RICHARDS
Islington Keep Our NHS Public