Clinical Commissioning Groups (CCGs) are confident that they are the ideal solution to the problems that the NHS faces.  And perhaps they are.

But I think we need to ask how it is that these brand-new organisations are so confident that they can get it right, when generations of similar organisations (PCGs, PCTs, reformed PCTs) couldn't do it before them.

NHS is engaging in another reorganisation, which reorganises it beyond all recognition.  GPs will be in charge of deciding what the population needs (and not a moment too soon), supported by the expert services of Clinical Support Units.

However will they have a free hand?  Where is this taking healthcare in the UK?  And is it a prelude to privatisation?

The Public Services (Social Value) Act 2012 became law in March 2012, and is now mandatory as from 31st January 2013.

This means that all qualifying public procurements for services (basically anything that isn't excluded) has to take account of a broader definition of Value for Money than a simple cost-per-unit consideration.  This is excellent news for Communities, Community Groups, Community and Voluntary Services and Social Enterprises, and Charities.  it also means a bit more thinking and consultation for Procurement bodies (typically local authorities and NHS) but should not create any more actual work.

Andy Burnham, Labour's shadow Secretary for Health, says "the 21st century is demanding the full integration of Health and Social Care".  He speaks of Whole Person Care.

All over the world, the NHS is admired.for:

* best clinical outcomes (on balance, UK has some of the best outcomes.  Where the outcomes are poor, for example cancer compared with other European countries, UK population unfortunately indulges in far worse behaviours of diet and exercise)

The Competition Commission is launching a probe into the probity and independence of NHS services [HSJ 19 June 2012]. They have identified two areas where there may be a conflict of interest:

• GPs referring patients into GP-owned services
• triage services which decide whether to refer patients into their own secondary care

The issues do need exploring. Who are the best people to design services? And who are the best people to run them? To what extent can we trust individuals and organisations who have a vested financial interest? Are the systems under regulated, or overregulated?

This is a new era for the NHS, a time when GP practices can begin to deliver the services that patients want, close to home.  We haven't had a chance like this since the PMS contract of 2004, or Fundholding in the 1990s.

Health services can now care for many diseases that only a few decades ago were fatal.  Each disease or disorder that becomes treatable goes through these stages:

Most healthcare providers, in UK the same as everywhere else, get paid for each activity they do.  If someone needs care, they get paid.  If someone is well, they don’t.  So there isn’t much incentive (for the healthcare provider) to keep people well, even though it is much better for the person, much better for the nation, and much lower cost.  Minney.org Ltd is working with one CCG to generate enthusiasm and involvement, and the results are fairly successful….

As we race forwards into clinical commissioning, there are lessons to be learnt from other people.  The latest book “The Innovator’s Prescription: A Disruptive Solution for Health Care” by Christensen, Grossman and Hwang points to some things we need to take account of. It makes good reading . . .

Clinical Commissioning Groups (CCG), the organisations that will commission  healthcare for nearly 60million people across England at a value of around £70billion, are beginning to take shape.

They come in essentially three types, and if you want to supply healthcare to these CCGs, even if you are an established provider of healthcare, you need to understand what you are dealing with