Over the past 10 weeks, the government has paused in its rush to reform the NHS. It decided to have a bit of a rethink.
One of the major issues it was rethinking about was whether the extent to which its original plan gave GPs control of local NHS commissioning could be allowed to go ahead. It has changed its plans in a number of significant ways.
It has changed its timetable on clinical commissioning from one that would have made all parts of England start at the same time in April 2013. It has moved this to a more relaxed timetable with no deadline for universal coverage.
Ready and willing
Now its new plan is that by April 2013 some clinical commissioning groups will be ready and willing to take charge of NHS commissioning.
Others will be part of a shadow commissioning group, which, from that date, will not be commissioning NHS care but will have their commissioning carried out for them by the NHS Commissioning Board.
The plan goes on to say that: 'No individual GP will need to get involved in the work of a commissioning group if they do not want to.'
The government has therefore slowed the rush it was in to cover the entire country with GP commissioners within the next 22 months and this must mean that GPs can look at this process in a more relaxed way.
There are also significant changes to the organisations that GPs will lead to carry out commissioning. Over the past year, the government had failed to make the case to the public that GPs had a special relationship with NHS referral and should therefore control local commissioning.
Other clinicians complained that they were being excluded from commissioning and in the absence of a proper story for the government, it just looked like special pleading for one group of doctors over the others.
So the reformed reforms will change the law to enforce nurses, consultants and other clinicians on the statutory GP commissioning consortia that will commission local NHS care.
The government has also changed the name of the commissioning organisation from GP consortia to clinical commissioning. This is much more than just a change of name. The Bill will be amended to make sure that every commissioning group will have a governing body which by law will have non-GPs on the board.
There will have to be two lay members - one with a lead role in patient and public involvement and the other with a lead role overseeing audit. One of the lay members will be chair or vice chair of the board.
In addition, the board will have to have at least one registered nurse and a secondary care specialist.
While these are legal impositions on the boards, in fact all of the future groups of GPs that I had come across were going to have nurses and members of the public on their boards. What will be different now is having their constitutions detailed by legislation. Parliament will decide who will sit on these boards.
For some GP leaders this will prove difficult. In their medical work, GPs pride themselves on being able to run the organisation that provides the framework for their NHS care. One of the reasons for choosing GPs to be in charge of NHS Commissioning was because they had proved themselves to be capable of setting up and running organisations by themselves.
GPs organising the work of other GPs and primary care staff has become the hallmark of most of the NHS care interactions with the public. Left to themselves, GPs have developed not just models of care, but methods of organising that care.
What will be different now is that unlike all other forms of GP organisation, GP leaders will now have to commission care from an organisation detailed in legislation.
For GPs to retain a strong influence over organisations which will have a range of different people on their board, they will need them to possess a degree of organisational politics. You will not be allowed to commission at all unless you have a range of different people on your board. So the question is how do you comply with the law and those expectations, but still ensure that there is a new approach to the strategic commissioning of NHS care?
Because whatever the structure of local NHS commissioning organisations, they will have to commission care that provides significantly better healthcare outcomes with the same resource.
So if GPs are going to develop a much greater influence over local NHS commissioning, they will have to do so without the control of those organisations that they had been led to believe would be theirs.
- Professor Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at www.paulcorrigan.com