As the Health and Social Care Bill awaits its third reading in parliament, this is a vital time for GP commissioning consortia to focus on delivery rather than structure.
Health secretary Andrew Lansley states the Bill is legislation for accountability and outcomes. The key is to redevelop within the NHS an alignment of clinical and financial accountability to facilitate improved outcomes, by linking clinical decision-making with responsibility for the resulting use of NHS resource.
Therefore, for clinicians in primary care, the process of GP commissioning needs to be included in every consultation in every surgery and clinic in England, every day.
Five challenges for GPs:
1. Making the NHS patient-centric
'No decision about me without me' requires this. As a minimum, consortia - or their constituent practices - must demonstrate not only how the patient's voice is heard throughout the organisation. It must also show that patients are deeply and inextricably involved in local commissioning plans and decisions.
This will mean more than just a token 'patient representative'. All constituent practices should have a democratic process through which patients help to identify the needs of the registered population and how best to meet those needs.
2. Reinforcing the multidisciplinary approach
Of all patient contacts in the NHS, 80 per cent are within general practice and number some 300 million consultations a year. Focusing the majority of clinicians' commissioning efforts on improving efficiency, demand management and health outcomes at that patient interface is appropriate.
However, as with previous clinical commissioning development, consortia need to ensure an inclusive and multidisciplinary approach to patient needs assessment and care delivery by involving all healthcare professionals working in general practice and the community.
3. Working closely with local authorities
There is a clear and urgent need to start dialogues, new relationships and integrated working with local authorities (LAs), in particular with social services.
Health and social carers need to liaise with each other on a regular, if not daily basis.
Strategic planning at consortia level needs to be closely aligned with the public health agenda as this will be part of LAs' remit. Current commissioning expertise at LAs needs to be aligned with GP consortia commissioning.
4. Creating a seamless service
An integrated approach to maximise quality and productivity has long been debated and desired. Consortia must facilitate dialogue between primary and secondary care clinicians about right care and best care pathways.
Secondary care is not 'the enemy'. But expanding services delivery in the community does means instead of, not as well as, hospital services.
This has major implications for sector reorganisation and the resulting NHS estate (buildings) redesign.
5. Expanding primary healthcare teams
Capability and capacity issues within GP practices must be addressed if consortia are to succeed. More patient care delivered out-of-hospital means new challenges for practices.
So primary healthcare teams must expand and increased skill mix is needed. Central to successful delivery is the drive to 'make more and buy less' for the registered population. During this transition phase, consortia efforts must focus on these challenges.
In 22 years as a GP, I have seen many attempts at reforming our NHS. The Health and Social Care Bill gives us a unique opportunity, to reform care rather than merely restructuring the NHS.
- Dr Kingsland is National Clinical Commissioning Network lead.