DR Paul Bowen, GP with McIlvride Medical Practice, Poynton, and GP Chair of NHS Eastern Cheshire Clinical Commissioning Group (CCG), talks about the ways in which the CCG can face up to difficult decisions in the future.

There has been a lot in the media recently about NHS finances.

The CCG, which buys care on your behalf, has a legal duty to fund services within a nationally determined budget that we cannot exceed.

While the trusts and organisations we buy care from are struggling to manage increasing demand for their services with the money provided to cover their costs.

The multiple reasons for this situation can be debated at length, but there is a rising tide of debt within our system that cannot be ignored. This pushes us into really difficult ethical decisions.

Ethical decisions in medicine occur day in, day out.

There is no right or wrong choice, just options with various consequences. There are just as many ethical issues in the ways we buy healthcare.

Some services we pay for ‘per consultation’, others via a block contract irrespective of the activity, and some based on outcomes.

Imagine paying a fireman only if they attend a fire, not if they prevent one by installing a fire alarm. Imagine paying a teacher in one school for working five days a week, but in another school only if they get a good Ofsted report.

This is the reality of health commissioning. And it is really difficult to change. Instead, we are forced make decisions as to whether we disinvest in one service over another.

What is more important to you, good access to your GP or a local A+E? Better dementia care or better teenage mental health? One drug that cures one person, or 100 drugs that protect 100 people?

There are no right or wrong answers, and everybody will have an opinion.

I remain optimistic that we can transform both the way we buy health and wellbeing services, and the way they are provided and delivered, but in the short term at least, these difficult decisions will be faced by CCGs around the country.

As a clinician, they are impossible without sound, well evidenced conversation with our communities and front line staff.

You and your local GP, as a member of the CCG, can help inform and influence the decisions the CCG has to take.

As chair, I must be assured we have weighed up all options, and their consequences, in order to make the best decision possible.

To get involved visit easterncheshireccg.nhs.uk/News-Events/public-engagement.htm or email kate.banks1@nhs.net.