At 69 the NHS is in its last gasps of life.

Silently asset stripped by large corporate multi nationals and managers.

And strategic cost cutting is used to streamline services into lucrative cherry picked privatisations.

And at the same time more money is pumped into the NHS as the solution to its woes.

Money used for its more lucrative, privately grabbed ‘services’ like mental health whilst A and E and frontline services remain starved.

So much so that over 20% of the NHS total spend, is now on mental health but only 7% on GPs, with 7 minutes consultations, herded as salaried GPs, into ever larger corporate practices.

All ‘legalised ’under The Health and Social Care Act on the lie of GPs commissioning the best services for their patients on ’competitive’ tender.

In 2016/17 NHS England transferred £71.9 billion to Clinical Commissioning Groups.

These groups are responsible for the commissioning and delivery of regional NHS services.

All GPs are members but by 2014 only half of GP practices felt involved in CCG decision making processes.

https://www.hsj.co.uk/news/commissioning/fall-in-gp-engagement-with-ccgs-nhs-england-survey-finds/5075901.article#.VFa5Hp_raKI

Meanwhile GP Practices are being merged into corporately owned super GP Practices with 70,000 patients on the excuse of cost cutting.

http://www.pulsetoday.co.uk/your-practice/practice-topics/employment/hospital-in-mass-takeover-of-gp-practices-will-soon-have-70k-patient-list/20034631.article

Yet, on an analysis in 2015 of more than 2,500 CCG managers, 56% of 225 were paying themselves more than the salary range recommended by NHS England of £95,000 to £125,000 a year.

http://www.dailymail.co.uk/news/article-2987218/NHS-bureaucrats-140-000-20-bosses-award-higher-salary-PM.html

CCGs have merged 211 to 174, and many are outsourced.

And by October 2014 NHS England had introduced a special measures regime for those in financial difficulties.

At least 20 may have already been placed in special measures and taken over.

Shropshire Clinical Commissioning Group was put in special measures with a deficit of £10.6m for 2015/6.

Bristol, South Gloucestershire and Somerset’s 3 CCGs were taken over by one chief earlier this year.

https://www.hsj.co.uk/hsj-local/commissioners/nhs-bristol-ccg/special-measures-ccg-group-hires-stp-lead-as-joint-chief-officer/7015665.article

And it continues in 2017 see here

http://voxpoliticalonline.com/2017/03/23/more-nhs-trusts-are-in-financial-special-measures-all-part-of-the-tory-privatisation-plan/

These multimillion pound deficits/debts ploughed into executive salaries and private foundation trusts coffers.

CCGs were told by NHS England to procure ‘support services’ by a tender process by April 2015.

The first of such ‘support services’ for South Lincolnshire and South West Lincolnshire CCGs was won by Optumhealth, who were given a £9 million 3 year contract, this being half the total running costs of the CCGs.

Optumhealth is part of US United Health Group, which employed Simon Stevens for 9 years, after he left his position as Blair advisor, he is now head of NHS England.

https://www.hsj.co.uk/news/commissioning/updated-private-firm-wins-first-full-commissioning-support-tender/5090717.article#.VhP3uUpfZ1A

When originally established CCGs did not have any responsibility for Primary Care, which was commissioned and managed by NHS England.

But in November 2014 CCGs were invited to become co-commissioners of primary care in their area.

Responsible for the performance, management and budgeting of their member GP practices including managing complaints about practices and GPs.

Foundation Trusts are being converted to private companies like Sheffield Health and Social Care and are buying up GP practices.

http://www.pulsetoday.co.uk/hot-topics/stop-practice-closures/five-gp-practices-merge-with-hospital-trusts-to-shore-up-their-finances/20034282.article

And working along side all Primary Care ready to purchase other GPs etc

http://www.primarycaresheffield.org.uk/2016/02/29/pcs_and_shsc_to_run/

Sheffield Health and Social Care Trust became a private company in 2015, with the board of directors of the Trust made directors and it includes the Clover Group of GP practices – Darnall Primary Care Centre, Highgate Surgery, Jordanthorpe Health Centre, and the Mulberry Practice, supported living services and respite care services.

And in April 2017 it had taken over the management of six Gp practices with a GP list of 26,500

Here are the minutes of the Health and Wellbeing meeting of Reading 2017

Click to access Item02.pdf

And the contracts for the GP practices are for 15 years, so try bind future Parliaments despite Parliamentary Sovereignty, quality of service and patient choice..

What now then is the distinction de facto between the Commissioner and overseer of services- the Clinical Commissioning Groups, and the Foundation Trusts providing the commissioned services ?

At 2019 CCGs were being merged without even consultation let alone approval of GPs https://www.gponline.com/gps-power-veto-ccg-mergers-bma-warns/article/1592017

What effectively is the function of CCGs now?

CCGs appear to have been a device to legitimise commissioning of services from the Foundation Trusts until they are set up and running.

And then the CCGs will be surreptitiously merged and subsumed into private service providers allowing self regulation and autonomous service provision.

The eventual goal; a few supersized, too big to fail providers, controlling our public 100 bn pound + budget, whilst accountability falls on NHS England- the tax payer.

An opaque, totalitarian mess, without oversight, riddled with self and conflicts of interests. Without competition nor patient voice.

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