Standing at a crossroads
Summons speaks with influential Department of Health advisor on clinical commissioning Dr James Kingsland about the case for urgent and radical NHS reform in England
having worked for years as a part-time GP advisor to the Department of Health in England. He is currently the National Clinical Commissioning Network Lead – a position which gives him a direct line to Ministers.
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Dr Kingsland was previously a personal advisor to Lord Darzi and was instrumental in the development and implementation of PMS policy. He served for four years as chairman of the National Association of Primary Care and is currently president of the organisation. Having practised on the Wirral since 1989, he is a senior partner in a PMS practice in Wallasey which was an early adopter of practice-based commissioning and is now in a first wave pathfinder consortium. Among many other roles he also serves on the NICE Commissioning Steering Group and is a non-executive director of Clatterbridge Centre for Oncology Foundation Trust. Dr Kingsland is married with two daughters and enjoys golf, football (having only recently given up playing five-a-side), music and broadcasting, being the resident doctor for BBC Radio Merseyside
Do you think the NHS in England needs revolution rather than evolution? It depends what you mean by the words.
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R JAMES KINGSLAND has long been a champion of practice-based and now GP commissioning,
Revolution brings to mind overthrowing regimes and bringing down governments. I’ve heard Sir David Nicolson say – this [NHS reform] is not a revolution but an evolution as in fish-to-man in two years. It’s really somewhere in between. It’s not revolutionary in dismantling everything we’ve built to date; it’s building on the best of what has been successfully created since1948. But the urgency to improve productivity in the current financial climate, does not allow for a slow incremental change; it’s got to be rapid and quite far-ranging.
What does your role as National Clinical Commissioning Network lead entail? What we are trying to do is develop a collective understanding of the reforms right across England and connect leaders in commissioning – emerging and established. Te network is system-wide in terms of geography but also in clinical disciplines– recognising that while GP commissioning boards will be led by their constituent general practices, the redesign of care services, the reform of our NHS will be delivered by a multidisciplinary team approach. Optometrists, dentists, pharmacists have a massive repository of information about local populations and individuals. AHPs, community and practice nurses are all resources in themselves, commit resources and do needs assessments – which is all part of commissioning.
Why is there so much opposition to the health reform bill among GPs? Tere has been a lot of scare-mongering, misinformation and misunderstanding, and – sometimes – a mischievous interpretation of what’s required. I think the narrative – articulating exactly what it is that we expect GPs to do – has also been lacking. I hear GPs say: ‘yes, we want patients to be involved, to be the source of control in the system rather than the current inherent managerial control, and yes, we would like to have more say in how NHS budgets are deployed. We do want to improve outcomes for patients and be involved in care pathway design – but we don’t like the reforms’. I can only reply: ‘well what you have just described is exactly what the reforms are for. So why don’t you like them?’ And the answer is: ‘that’s not what we’ve been told. We’ve been told we’re going to have to manage contracts, procure new services and take on complex roles previously performed by PCTs thus taking us out of practice, and we’re going to have all this extra bureaucracy’. Well, I say: ‘who ever told you that is either being very divisive or is poorly informed’.
People misunderstand the word ‘commissioning’. What healthcare managers mean by commissioning is the procurement of health services and contract management. But for clinicians, commissioning focuses on the first part of
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