Exclusive: DoH czar explains how commissioning will affect all GPs

In an exclusive interview, DoH commissioning czar Dame Barbara Hakin explains to Neil Durham how every GP in England will have a commissioning role.

Dame Barbara: ‘The government has made it very clear that the focus, the core of clinical commissioning, is general practice'
Dame Barbara: ‘The government has made it very clear that the focus, the core of clinical commissioning, is general practice'
Exclusive video: Dame Barbara explains why NHS reform is 'exciting'

'I think it's a more significant reorganisation, it's the first one to have such a massive impact on clinicians.'

Former GP Dame Barbara Hakin, now DoH commissioning czar, is answering the question: ‘How does the current NHS reorganisation compare with ones you’ve worked through previously?’

‘We’ve had significant reorganisations before,’ adds Dame Barbara, who qualified as a GP in the late seventies and was part of the DoH-side negotiating team which agreed the 2004 new GMS contract. ‘But never one that has made such a change putting clinical leaders at the heart of the way the NHS does its business.’

But how should GPs feel, post NHS Future Forum report, now the emphasis is on clinical, rather than GP-led, commissioning?

‘The government has made it very clear that the focus, the core of clinical commissioning, is general practice.

‘With service redesign and quality it’s really important that a broad range of other clinicians are involved. But the vast majority of nascent commissioning groups already had this in mind. This just makes their inclusion clear.’

Isn’t there a danger that NHS Future Forum changes will dampen GP enthusiasm?

Dame Barbara replies: ‘The enthusiasm is still very significant. More people want to understand some of the aspects and exactly what that means for them.’

But won’t GPs who want to commission now be tied up by bureaucracy?

‘We shouldn’t underestimate the enormity of the task for clinical commissioning groups (CCGs) to be responsible for the vast majority of healthcare services for a population and a large sum of taxpayers’ money.’ Dame Barbara adds eradicating unnecessary bureaucracy is key.

Pathfinders currently cover 97% of England but what happens in areas where there is no enthusiasm for them?

Dame Barbara says: ‘I know of no area where there is no movement towards defining broadly the shape of a CCG, although there are some individual practices that aren’t sure they want to be part of clinical commissioning but there aren’t very many.’

So what happens in areas where practices don’t want to be part of commissioning?

‘The Bill makes it quite clear that all practices will need to be at the very minimum in a clinical commissioning consortium but there will be different levels of involvement.

‘What I want every GP to do is to understand how their actions and interactions on a daily basis have an impact on the pathways and better care for patients so, through their provision of services, GPs automatically commission.’

She adds that it is already a duty on GPs to use NHS resources wisely, that GPs should not be put in a position where they have to change what they might offer patients because of resource allocation but that waste should be eliminated.

Dame Barbara continues: ‘We want one or two GPs in each practice to take a more  significant role in ensuring systems and processes in the practice help with the commissioning aim to get the best pathways for patients and the best value for taxpayers’ money.

‘Then we want a smaller number of clinicians in primary care to take responsibility for very specific aspects, for example diabetes or chronic disease management.

‘There will be an even smaller number who will want to get significantly involved in the leadership of the CCG.’

By the end of this month detail about the authorisation process for CCGs should be available.

Dame Barbara adds those most likely to progress quickly are ‘groups that have a settled geography and membership, are confident themselves and can demonstrate that they can commission for their population’.

CCGs will not be able to be authorised until the NHS Commissioning Board is up and running, which is expected to be summer 2012.

Dame Barbara clearly believes in the ability for commissioning to empower clinicians. Her realisation that it represents the largest re-organisational impact for clinicians during her NHS career undoubtedly also means she understands the nervousness on the ground about the new responsibilities it presents for GPs.

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