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ommissioners of care need a lot of support – and they will continue to do so.
Despite the rhetoric of ministers ever since the original white paper, it was never the idea for GPs alone (or even GPs with a bit of back-up from a nurse and a consultant) to commission everything themselves.
That’s where ‘commissioning sup- port’ comes in; it’s had virtually no public attention, but it goes to the heart of what many medical profes- sionals have against the NHS re- forms. The worry is that the vast ma- jority of the behind-the-scenes work of commissioning – and not just the ‘back offi ce’ – ends up being shifted from NHS staff working within the NHS, at the PCTs, to commercially- driven set-ups, from social enter- prises to the private companies that have already had so much advice to give to policy-makers.
Of course, this concern doesn’t sit too well with another frequent criticism: that PCTs are going to end up being virtually re-created and many of their staff re-hired. Indeed, commentators including Paul Corrigan have noted Health Secretary Andrew Lansley’s advice to clinical commissioning groups that they should be looking to hire people from within PCTs, because they have the skills needed to do the job.
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Whether or not this has anything to do with avoiding redundancy pay-outs, as was suggested, the point remains that Lansley knows it is impossible for clinicians to ‘run the NHS’ and take all the decisions
themselves. For all his dismissive talk of ‘managers’ and ‘adminis- trators’ and ‘bureaucrats’ in public and when trying to fi nd the all- important narrative to explain to a sceptical public why an NHS that they see as basically working well needs such radical reform, he is fully aware that many of these jobs need doing.
But Department of Health draft guidance, pounced on by the BMA, urging commissioning support units that will succeed PCTs to form partnerships with the private sec- tor from 2016 to sell their services to clinical commissioners, suggests that ministers are all too happy for this function to be based outside the NHS, organisationally. Com- mercially-focused criteria would be used when choosing commissioning support, the BMA says, meaning that it would be “almost impossible” for clinical commissioning groups to do it themselves, in-house.
The doctors’ union has used this as a peg on which to hang its opposi- tion to the entire Health & Social Care Bill – not that it was ever about to become a cheerleader for it.
The Department of Health has in- sisted that the BMA is seeing sinis- ter motives where none exist, and has “misunderstood” its intentions – and, vitally, that the clinical com- missioning groups will have the independence and power to make their own decisions on commis- sioning support.
Staff working in PCT clusters at the moment are deciding for them- selves where their future lies, and some are realising that it might not be at an organisation with ‘NHS’ in the name – even if their job still in- volves supporting healthcare com- missioners.
Editor Adam Hewitt
31 Targeted Testing Donal Heath describes a new partner notifi cation service.
32 John Clark explores
management and leadership in the NHS post-Griffi ths.
46 Balancing mood Jon Cousins discusses an innovative healthcare tool.
79 Stronger together With Tom Humphries of the One Health Alliance.
national health executive Nov/Dec 11 | 1
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