COMMISSIONING
Co-operative commissioning Michael Dixon
on this extra responsibility to whether time which GPs should be spending with patients will be taken up by additional paperwork.
T
he reforms outlined in the white paper are the culmination
of what the NHS Alliance has been pushing for for years - for clinicians and patients to have a much greater say in local health services
The government’s plans for the NHS have faced a lot of criticism and even calls for a judicial review but have also been welcomed in some quarters, such as the NHS Alliance.
“This all very much in line with what the Alliance has been upholding for a long time,” says NHS Alliance chairman Dr Michael Dixon.
“We have been pushing for this for so long and, in that time, we have seen fundholding, total purchasing pilots, locality commissioning, primary care groups, primary care trusts and then practice based commissioning.
“However, none of them have quite loosened the system sufficiently to create the sort of radical change which we need around devolving services from hospitals to communities.”
Despite this upbeat appraisal, there are still many of those who have voiced concerns on a variety of areas, ranging from GPs’ willingness to take
26 nhe
“I don’t think that GPs will be stuck doing paperwork or accounts. This is because this reform will move management in the NHS to a different place. I also don’t think that we will have many good managers leaving the NHS. I hope that they will be there, supporting and co- leading with GPs in this new commissioning structure.
“Worries about GPs either not wanting to take this role or not even being able to do it are misplaced. This new vision is about strategy and leadership, not detailed implementation, which will continue to be the remit of our excellent NHS managers.
“We need to get this right, without destabilising or creating too much disturbance in the system. People are bound to be worried about the future of their jobs .
“Whilst I believe that GPs leading the consortia would have
to become more management savvy, it is fair to say that the managers working with them will have to become clinically savvy as well. I don’t feel that GPs want to take on management jobs. What we’re seeing is a realigning of front line staff versus central control and a more equal relationship between clinician and manager, which is contrary to the current system which involves a very tight management hierarchy coming from Whitehall, with clinicians rather left out of it.”
Given that primary care trusts are to be dissolved, concern has been expressed as to where managers will fit into the equation.
“I would hope that the vast majority will form part of the GP consortia , which will need very good managers to implement the systems and processes - such as contracting and procurement..
“Other managers, I believe, will become part of the central commissioning board, as it will be this board which will be responsible for monitoring GP contracts - along with other disciplines such as dentistry -
and therefore will require some local knowledge.
“Whilst I don’t think the government is going to want to recreate health boards or the like in a hurry, in principle there is going to have to be some kind of outreach management to monitor the GP consortia as well as other primary care contracts.”
Whilst there would be few who would not welcome a more clinician-led health service, some have raised concerns that many GPs are now essentially businessmen and that by giving them more control over health budgets, there is a risk that profits may be put before patient care.
“I very much share those concerns and that is why the Alliance brought out a document before the white paper was announced, which looks at co- operative commissioning.
“If GP consortia are a form of social enterprise or a co- operative, then people will see that the GPs are not profiting from it. That then does two things: first of all, it doesn’t fracture the relationship between patient and doctor, leading to stories in the tabloids about ‘fat cat’ GPs, and secondly, if there is a co-operative model of commissioning which brings local patients and clinicians together, then this allows for a much more effective approach towards co-productive treatments such as self-help and improving personal or community health.
“It seems to me that a co- operative model makes sense, not only for the image of the GPs, but for the sustainability of the NHS in the future.”
Nov/Dec 10
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