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Tuesday 27 September 2016
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Clinical leadership fears after Lewisham A&E decision

Fears that health reforms would not result in clinical leadership have been demonstrated in Lewisham, according to GP leaders. 
 
The recent decision to downgrade Lewisham’s A&E department to save money for a neighbouring trust has been described as a “kick in the teeth” by a CCG leader. 
 
“It’s basically saying although clinicians in Lewisham know about their patients, it doesn’t matter because other people’s concerns are bigger than ours,” Dr Helen Tattersfield, Lewisham CCG’s chair told The Commissioning Review. 
 
Dr Tattersfield claimed that although local clinicians took part in consultations, they were not listened to by government officials. 
 
“We were told their plan was the only thing that would work, and they weren’t going to listen to us,” she said. 
 
Old-style management
 
Deputy chair of the BMA’s GP Committee, Dr Richard Vautrey, believes the Lewisham decision “doesn’t bode well.” 
 
He said: “There’s been a lack of willingness to allow clinicians to make decisions. This smacks of old-style NHS management. 
 
“It would appear that as long as CCGs make decisions which are in line with what others higher up want, they will be supported.” 
 
Francis Report
 
Dr Tattersfield said the decision to downgrade Lewisham was the “exact opposite direction” to the suggestions of the Francis report. 
 
She said: “This is managers making decisions based on money without taking into account relationships, patient views, experience and all of those things which Francis says are paramount.” 
 
Dr Peter Swinyard, Family Doctor Association Chair said Jeremy Hunt’s decision was “one of the worst decisions [I have] ever come across” and it “puts out a bad message”. 
 
“CCGs have the potential to do great good, but I think the Lewisham decision is enough to put the whole commissioning agenda in danger,” he said. 
 
Need for clarification 
 
Last week Lewisham CCG sent a letter to Sir Bruce Keogh, who put forward the recommendations, asking for clarification on their role as local commissioners. 
 
In the letter, the CCG said its members are “baffled”, feel “consistently ignored”, and will not make further decisions until they understand their role. 
 
“What we’re trying to do at the moment is find out what [Jeremy Hunt’s] changes mean,” said Dr Tattersfield. 
 
NHS Alliance Chair Dr Michael Dixon said although the situation was not “acceptable” or “practical” the Health Secretary and Sir Bruce Keogh were trying to fix a bad situation.  
 
Dr Dixon told The Commissioning Review he hopes CCGs will “wear the trousers from April 1”. 
 
“The problem is, at the moment CCGs don’t have their feet under the desk, but from now onwards any decisions should only be made with CCG agreement,” he said. 
 
Back to the practice
 
Dr Dixon questioned what the point of creating clinical commissioning groups would be if they are not be listened to. 
 
Dr Peter Swinyard said continuing to ignore GPs decisions would make “the majority of sensible GPs” want to “go back to their practices and carry on looking after patients”. 
 
“GPs are intelligent enough to know when they are wasting their time. We are tolerant of many things in general practice, but time-wasting is not part of our remit,” he added. 
 
Lewisham A&E
 
Following Sir Keogh’s recommendations patients with serious conditions will be sent to other hospitals, while up to 75% of those currently attending would use a smaller service at Lewisham A&E.
 
Close to £1.3 million per week was lost by the South London Healthcare NHS Trust, which was £150 million in debt when it collapsed. 
 
The Department of Health has yet to comment.