Why commissioners need legislation

There is no intention to privatise the NHS in the Health Bill, writes Dr Stewart Findlay

Dr Findlay: 'As clinicians we are being given an opportunity to comm­ission services for our patients and to drive up quality. If we mess it up, such an opportunity may never arise again' (Photograph: UNP)
Dr Findlay: 'As clinicians we are being given an opportunity to comm­ission services for our patients and to drive up quality. If we mess it up, such an opportunity may never arise again' (Photograph: UNP)

We hear Health Bill opposition on a daily basis from the royal colleges and from the BMA.

Occasionally we hear support for clinical commissioning from the NHS Alliance and the Nat­ional Association of Primary Care and sometimes from ind­ividuals, such as me, who with more than 50 other commissioning leads, signed a letter to The Daily Telegraph warning of the dangers of calling for the Bill’s withdrawal.

We are told that 98% of RCGP members oppose the Bill but when you look at the numbers that voted, it amounted to only a fraction of its membership. It is therefore misleading to use this statistic and what it probably demonstrates is that the majority of its members are not concerned enough about this Bill to even vote.

Ready to take on budgets
About 95% of clinical commissioning groups (CCGs) are now ready to take on budgets from 1 April, a full year before they are able to become statutory bodies (GP, 22 February).

A total of 62% have been rated as green by their SHA on their engagement with their local practices and only 1% were rated as having no support from their member practices.

When our practices voted on our CCG structure recently, more than 90% of practices voted. I think this demonstrates that at a local level practices are engaged and interested in the proposed new commissioning organisations.

The relationship with our PCT managers has also changed since the Bill began its progress through parliament. We have been working more closely with our managers than we have done for many years and the result is that many of our pathways and our commissioning intentions are becoming a reality.

The processes are of course still too difficult and too bureaucratic and this will be one of the first things CCGs will have to change in the future if we are to deliver higher quality care, quickly and in a difficult financial climate.

Some may argue that this demonstrates that change could have happened under existing legislation. The problem with that idea is that we tried that with practice-based commissioning, and it did not work.

If clinicians are to be central to commissioning in the future we need legislation to make CCGs statutory bodies.

Privatisation of the NHS
Opponents of the Bill have arg­ued that it will lead to the privat­isation and fragmentation of the NHS. I have been a GP now for nearly 30 years and have been able to refer my patients to private hospitals since the early 1990s.

In the 1990s we also saw the growth in what are now des­cribed as any qualified provi­ders. They were pharmacists, counsellors, physiotherapists, GPs and, in some cases, consultant colleagues who wanted to provide care in a community setting that was more convenient for our patients.

This is good for patients and has not posed any threat to our NHS providers over the past 22 years. In fact, my experience is that they have often risen to the challenge and have become involved in prov­iding more local services themselves.

We must also remember that private providers cannot force themselves on patients or CCGs. The services have to be commissioned and patients have to choose to use them. If the Bill comes to pass, that choice will be clinically led and informed by our patients.

Key points
  • Health Bill may be the last chance for clinicians to lead on commissioning.
  • There is local support for CCGs.
  • There is no evidence there is any intention to privatise the NHS.

Commissioning support will also move out of our PCTs in to new and probably much larger commissioning support units (CSUs). CCGs are likely to be lean organisations and will buy in support as and when it is needed from CSUs.

Up until 2016, CSUs will be hosted and to an extent protec­ted by the NHS Commissioning Board. This is wise and it protects NHS staff as they transform into customer-focused organisations, supporting CCGs to carry out their commissioning functions.

Ultimately CCGs will be able to choose where best to commi­ssion their support and it may be that some will choose to buy in some services from their local authority or from the private sector. It is however important that CCGs have a choice and can eventually buy in their back office services from the best available providers.

Joint strategies
The Health Bill is of course not just about clinical commissioning. It legislates for developing joint commissioning strategies with our local authorities through health and wellbeing boards, it legislates to reduce inequalities and to continuously drive up the quality of care through the new outcomes framework.

It will legislate for changes to Monitor as a regulator of healthcare and will impact on the provision of public health services and medical education.

However, I cannot see any intention to privatise the NHS in any of this. There is a lot of local support for clinical commissioning and even the BMA and RCGP are in favour of this aspect of the Bill.

As clinicians we are being given an opportunity to comm­ission services for our patients and to drive up quality. If we mess it up, such an opportunity may never arise again.

That would be bad for the NHS, bad for primary care and ultimately it will be our patients who suffer the consequences.

  • Dr Findlay is commissioning lead for the Durham Dales locality, part of the Durham Dales, Easington and Sedgefield shadow CCG, County Durham

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