COMMENT
specialised components where staff were unable to see the bigger picture. This led to criticism from workforce development staff that commissioners were often unable to take a strategic view.
It also meant that commissioners’ skills did not fully meet those defined in the National Occupational Standards. We would expect the requirement in the world of GP commissioning consortia to be for broader skills and that their commissioners should attain the National Occupational Standards.
In the new world, commissioners need to take a strategic view and we applaud the efforts being made by NICE and the Social Care Institute for Excellence (SCIE) to provide an evidence base for commissioners. The focus is now to learn from the experience of the past on implementation and how to embed this organisationally.
PCT reorganisation
The recent clustering of PCTs, where in one area of London three PCTs have been combined into one, with a reported loss of 60% of staff, has destroyed capacity that has been painstakingly built up through the ‘world class commissioning’ era. It doesn’t look as if there is any movement to build upon the ‘Taylorised’ skills of those remaining.
In addition, the council budget reductions have also led to the elimination of commissioning roles in key councils. When there are calls for councils to provide support to the GP commissioning consortia, again we fail to see where this will come from. Given the large numbers of posts which have been eliminated, we have termed the cull ‘commissioning genocide’.
Whilst green shoots will appear, the position on ‘clinical commissioners’ is just a rerun of 1997. Clinicians will be taken off the job and without guidance, will go through the same experience of other commissioners over the past few years. The scale and pace of reform again lacks a clear foundation of commissioning professionalism. This time, it is complicated by the need for efficiency savings and the inevitable political fallout.
Danger of collapse
We have been informed that encouraging commissioning professionalism is low down the list of priorities. How can an effective system be built without embedding a higher level of professionalism into organisations? The Health and Social Care Bill will require GP commissioning consortia to gain authorisation and to submit their ‘commissioning plan’.
How many GPs have produced a commissioning plan? The clear focus is on authorisation but where are the
experienced clinicians who have produced a commissioning plan?
It’s time for clear leadership in this area and without it, the reforms will collapse, as did ‘world class commissioning’.
If
commissioning skills are not embedded into the GP commissioning consortia, then the reforms will lack foundation and collapse. ‘Commissioning genocide’ will only help if it is used to learn the lessons of the past and develop commissioning like other mainstream professions.
This is a complex world where the detail does need to be fully thought through or else scarce resources will be wasted rather than being better used saving lives.
The Institute of Commissioning Professionals is a not for profit, member- owned organisation dedicated to improving commissioning standards, which has just published its new book,
‘Achieving
Commission in g Excellence’.
1 The Taylor Report: an
independent report into how Brent Primary Care Trust found itself £25m in the red in March 2007.
Doug Forbes FOR MORE INFORMATION
T: 020 8886 2462 W:
www.commissioning.org.uk
national health executive May/Jun 11 | 21
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