The Birmingham Health Service Management Centre has suggested that all healthcare commissioning should be carried out by local councils, while NHS staff concentrate on provision of care.
But why assume that councils would be better commissioners than clinicians?
The authors of the paper claim that local government is better at managing tight budgets, involving local people in setting priorities and communicating, yet there is widespread dissatisfaction with local services.
It is doctors who make the decisions that result in NHS expenditure. If you want to improve the cost-effectiveness of the NHS you have to influence clinicians. You can take a punitive or an incentivising approach, but the doctor-patient relationship will break down if patients come to believe that doctors are responding to other factors than their needs.
A better option is to give clinicians budgets and give them the responsibility for delivering the best care possible.
The lessons from both fundholding and total purchasing, and early experience from those PCTs that are well advanced with practice-based commissioning (PBC) suggest that this would be the case.
I am puzzled that there is so much opposition to clinicians having budgets.
PBC has not yet got off the ground, and the reorganisation of PCTs will slow its evolution. Few practices have real budgets, fewer are actually commissioning and even fewer have adequate data or management support, yet the call is already going out to give their budgets to local authorities.
Local government has not impressed me either as a commissioner or as a provider, or in its ability to gain the trust and gratitude of its population. There has been much thought given, by all political parties, to the question of local government reform. Now is not the time to transfer commissioning powers to organisations which have considerable question marks over their form and function.
PBC needs time to develop. Research and support to make these reforms work would be a better use of people's time than sniping. I hope we do not have a situation where some are so opposed to the notion of clinicians managing budgets that whatever is proposed will be shot down.
Dr Rhidian Morris
Retired GP, Ivybridge, Devon