BEING the boss of the North East Clinical Commissioning Group, can, by her own admission, leave Sam Hepplewhite lying awake at night.

Sam stepped up to the role 14 months ago after deputising to Dr Shane Gordon, whose departure to work for Colchester’s hospital trust, she says was a shock.

Sam said the clinical commissioning group had “many operational pressures in the system,” one major one being that it was approaching winter when health services really do feel the onslaught of poorly patients.

On her watch as his deputy and now chief officer, free IVF has been cut as have free vasectomies and children with learning difficulties have been told their clinic won’t run after May.

Tough decisions but then Sam, like health bosses up and down the country, has to be tough for what she calls “the macro population”.

The CCG, which serves an ever-increasing population people in Tendring and Colchester, has a projected £15million shortfall by March.

It is natural to ask, therefore, if we’ve seen the last of the cuts to services, which in some cases, have caused public outrage.

Sam pauses for a moment and you can see the concentration in her face as she mentally runs through her vast scale of responsibilities.

“I can honestly say we haven’t got anything in the pipeline about to go.

“It is really when we respond to the financial position at the end of the year I will know.”

There’s been quite enough for Sam to manage lately.

One of the major problems facing the CCG is a lack of GPs with more wanting to retire.

Sam explains: “The Government is looking to recruit another 5,000 in five years but it takes seven years to train. Those 5,000 are not in a cupboard waiting to come out. We have got to use our GPs in the most effective ways.

“We are going to look at enhancing the procedures done with other professionals.”

An example she gives is giving nurses powers to deal with patients who have long-term conditions.

“I think the solution is not just putting our eggs into one basket and trying to replace GPs.

“We have got to offer GPs other reasons for staying. Sometimes it is money but sometimes it is more about the work life balance.

“We have got to get in a position where north east Essex becomes a more attractive place for people to come to work and stay and bring up their families.”

Earlier this year Ranworth surgery in Clacton said it was becoming so overrun with patients, it refused to take on any more.

Sam’s view is that is a last resort but she adds: “Sometimes for the sake of the safety of patients for the short term that might be the right thing to do.”

However, in a bid to address this, the CCG has proposed co-commissioning our GP surgeries with NHS England, the part of the NHS which currently funds them, and it is hoped this could create “more of a dialogue” between the surgeries and the CCG.

The topic of GPs is one of the reasons why the CCG has most recently been talking with other health organisations to devise what they call the Sustainability and Transformation Plan.

Essentially it’s a strategy for all the groups to work together better, to support a dwindling workforce, patients with more long term conditions and boost quality of services.

“To the members of the public it shouldn’t really matter there are three separate organisations but sometimes all in that pathway does not meet.

“The way we have commissioned services means they are all provided by different organisations.”

The vision would be ideally for one person, for example, to assess a patient and their needs communicated to all relevant partners in their care – not the patient having to tell their story four times to four different people.

Which leads onto another recent proposal by the CCG to try to manage more patients, more efficiently.

It wants to create a single minor injuries unit in north Essex although this might mean closing current units at Clacton and Harwich hospitals and the walk-in centre in Colchester.

“Our hospital urgent care services are confusing, complicated. The same things can be called different things in different places. People are saying they haven’t got time to navigate the system so end up going to accident and emergency department at Colchester Hospital.

“But nowhere does it say we are having one site.

“All the relevant contracts end in 2018 so what we are saying is ‘What is it that will make a real difference?’”

She added the CCG was keen to listen to people’s views when it starts public engagement in January.

And Sam insists the proposals aren’t about saving money.

“If I am really honest we would have done it even if we didn’t have a £15million efficiency saving.

“We have got contracts that are coming to an end. Once we have got some idea of what the breadth of views are then we can say how much might be saved.”

Money is, however, finite. The decision by the CCG to withdraw free IVF for couples sparked outrage among couples trying to conceive.

Sam said she still didn’t know how much the move will have saved, again referring to the financial year end in March when the figures will be up to date.

It has also meant couples who were already listed to complete IVF cycles would be allowed to stay in the process.

To many, however, much of the above sounds as though our CCG has created something of a postcode lottery - services available or unavailable because of where you live.

“There are going to be some decisions that are not going to be popular with people and these will continue to be made as long as they are made within full sight of the public and they have the opportunity to inform that decision,” says Sam.

“I personally have to have a strong value base and to remember my values and moral compass.

“There have been some things that have kept me awake at night but if you stick with the processes and stick with being honest and thoughtful through things - that is how I align myself to it.

“It’s not the cuts that keep me awake - the things that worry me are if we have got a shortage of workforce in this area, how are we going to sustain these services and operationally?

“You go to bed knowing there might be four ambulances waiting to hand over patients because demand has reached capacity.”