CCG roadmap target a ‘tall order’

It is a “very tall order” to expect clinical commissioning groups to deliver digital roadmaps for their local health economy by April 2016, a GP leader has said.

NHS England announced last week that CCGs will have overall responsibility for delivering a paperless NHS by 2020 and will manage any funding made available to support this ambition. 

They must each submit a ‘digital roadmap’ by April 2016, showing how their local health economy will achieve the paperless vision.

Chairman of the British Medical Association’s GP committee Dr Chaand Nagpaul told Digital Health News that many CCGs are already struggling with the advent of co-commissioning.

With winter pressures coming up as well, it is a “very tall order” to ask them to put in place plans for full digitisation of their health economies by April next year.

“It’s an extremely ambitious time frame. We are finding that CCGs are having an escalating level of responsibility passed on to them without the commensurate increase in organisational capacity,” he explained.

“We run the risk of CCGs being asked to do too much when they they are already struggling. We need a realistic look at the capacity of CCGs and what is able to be achieved.”

Nagpaul said CCGs are in a good position to ensure a system-wide approach is taken to digitisation, but the paperless target should be everyone’s business, rather than performance managed by CCGs. 

He added that the strict separation of responsibility between either providers or commissioners is divisive and unhelpful.

“We need a much more joined up approach between commissioners and providers across the system with everyone signed up to achieving this change,” he said.

Beverley Bryant, director of digital technology at NHS England, said at NHS Expo in Manchester last week that CCGs have been chosen to lead on the roadmaps because they are best placed to manage the health economy and drive a focus on interoperability.

Guidance released in time with the announcement says CCGs must complete an online template defining the ‘footprint’ of their digital roadmap – the providers covered by their local health economy – by the end of next month. 

By November, CCGs and healthcare organisations will need to report back to the centre on where they are now in terms of their digital capabilities, which will feed into a new digital maturity index, to be completed in January 2016.

Planning guidance for the digital roadmaps is also due to be published that month and the roadmaps themselves are to be submitted by next April, in time to be published in June 2016.

The roadmaps will be considered as part of the CCG assurance framework from the next financial year onwards and CCGs should expect to be held to account for meeting the milestones in their roadmap, the guidance adds.

William Lumb, NHS Cumbria CCG chief clinical information officer, is in favour of the move to put CCGs at the centre of the paperless journey.

“I like the idea that they are allowing local health economies to be defined and they are not looking for a one-size-fits-all for all of the country, so it makes sense on a lot of levels,” he said.

But he warned of issues around competency and capacity when it comes to CCGs being able to deliver on the April target.

While some CCGs are forward-thinking and have been working on going paperless for some time, others do not have the maturity and competency within their organisation and rely heavily on commissioning support units or bigger CCGs to take the lead.

Not only is there great variation between CCGs, but also between providers in terms of their maturity and capacity. “We need to see how this spins out, but the principle is right,” Lumb explained.

He added that while CCGs can put interoperability standards into their contracts, NHS contracts are “very difficult to manage”.

Overall, Lumb believes the April deadline is achievable, but urges CCGs to work together to share knowledge about what is technically possible. “It’s not going to be easy; CCGs are going to have to work together and share.”

He said that he already knows what the basic roadmap should look like for Cumbria and has scheduled a meeting with his chief officer to start looking at what organisations should be within their group’s ‘footprint’.

However, it requires resource to both create a plan and then deliver it. “The powers that be have been very cagey about whether there will be any money to back this up. We absolutely encourage money being behind this,” he said.

Bryant confirmed at NHS Expo that NHS England is putting together business cases to go to Treasury to support the digitisation programme. Any funding made available will be managed by the CCGs.