UK's commissioning revolution
publication date: Jul 14, 2010
Putting commissioning, or the buying of services, in the hands of general practitioners (family doctors) is likely to be highly beneficial for the private sector and could create a new £1bn market.
It also marks an important move towards patient choice. The concept of removing commissioning from Primary Care Trusts and the Strategic Health Authorities, and giving it to GPs to run with input from patient groups, is a very big idea. It is also likely to provide a better answer to “who cares?” - the big question you should always ask when aiming for better patient outcomes. Put simply, GPs and patient groups are more likely to care than managers in PCTs and SHAs.
The issue now is 'who will fill the commissioning gap?' Although there are existing examples of successful commissioning by GPs, they conspicuously lack the expertise to commission on a major scale. The answer is that we will see an explosion in new intermediaries and consultancies who will provide the expertise GPs and patient groups lack.
The old model failed to work partly because when commissioning and providers were divided in two, the best brains typically went into the providers – running hospitals is sexier than buying healthcare services. This tended to mean that PCTs were second rate. Now, the best, and most expert, staff in the PCTs will transfer into commissioning consultancies.
There are many dangers ahead. The UK NHS has been through far too many reorgs already. There is also a danger of corruption. GPs will be commissioning services which they may then provide.
But there are benefits. First, it means that the wider medical profession is back in the driving seat and making the hard decisions. No longer can the profession stand to one side and blame faceless managers for hospital closures. Secondly, if anyone knows how to move patients out of expensive hospitals and into cheaper ambulatory services surely it is the GP community. Above all, involving patient groups answers the big question – “who cares”. That is a question that the NHS bureaucracy has been particularly poor at answering in recent years.
It also marks an important move towards patient choice. The concept of removing commissioning from Primary Care Trusts and the Strategic Health Authorities, and giving it to GPs to run with input from patient groups, is a very big idea. It is also likely to provide a better answer to “who cares?” - the big question you should always ask when aiming for better patient outcomes. Put simply, GPs and patient groups are more likely to care than managers in PCTs and SHAs.
The issue now is 'who will fill the commissioning gap?' Although there are existing examples of successful commissioning by GPs, they conspicuously lack the expertise to commission on a major scale. The answer is that we will see an explosion in new intermediaries and consultancies who will provide the expertise GPs and patient groups lack.
The old model failed to work partly because when commissioning and providers were divided in two, the best brains typically went into the providers – running hospitals is sexier than buying healthcare services. This tended to mean that PCTs were second rate. Now, the best, and most expert, staff in the PCTs will transfer into commissioning consultancies.
There are many dangers ahead. The UK NHS has been through far too many reorgs already. There is also a danger of corruption. GPs will be commissioning services which they may then provide.
But there are benefits. First, it means that the wider medical profession is back in the driving seat and making the hard decisions. No longer can the profession stand to one side and blame faceless managers for hospital closures. Secondly, if anyone knows how to move patients out of expensive hospitals and into cheaper ambulatory services surely it is the GP community. Above all, involving patient groups answers the big question – “who cares”. That is a question that the NHS bureaucracy has been particularly poor at answering in recent years.