Exclude private firms from commissioning’

Private firms should only deliver NHS services where no alternative exists, and should be cut off from all commissioning functions, the BMA has said.

In a report published this week setting out a vision for NHS reform in England, the BMA makes a number of recommendations.

It says: ‘There is no evidence that the private sector offers improved services or better value for money than the NHS.

‘NHS clinical services should be publicly provided as far as capacity allows; commissioning must remain in the public sector.

‘Private-sector provision should only be commissioned to meet a need which has been identified by the NHS and that it cannot itself meet. It should support the NHS rather than supplant it and there should be no further central procurement of private-sector provision.’

Another proposal would effectively end practice-based commissioning. The report calls for a shift away from markets and competition to a collaborative model in which commissioners and providers in primary and secondary care work together across regions, in some cases as PCT-sized ‘health economy foundation trusts’ (HEFTs).

The report says: ‘Areas should be encouraged to move toward single-system working, as exists in Scotland, where commissioners and providers work within a single structure. This is because efforts to move towards a different form of commissioning and the development of clinical networks may be frustrated by the formal existence of a purchaser–provider split.

‘A HEFT model could achieve this. Boards would include provider and commissioner representation from hospitals, GPs, community providers and public health.’

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