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Safeguarding the NHS – who really understands commissioning?

Wednesday May 11th, 2011

By Doug Forbes, Director, Institute of Commissioning Professionals

In watching the emerging debate on Health Reform, the key question is; what is the problem it is designed to fix? So far, it’s about the effect of the ageing population and rising costs. What has not been discussed is that the current system is designed to have budgetary control at PCT level. There is no financial or managerial control from the person who knows you – your GP.

Referrals to secondary care go with a code and many hospitals have rooms full of coders maximising revenue. Our members have reported considerable levels of overcharging and the GP who is a clinician has no role in challenging this situation. Surely the GP is the best person to challenge what other clinicians are doing? However, it is that detail which may sink the proposed system, as GPs get bogged down with trivia.

The argument against change is well advocated, but many opponents believe that commissioning means privatisation. The later stage of the committee process in Parliament was meant to provide colour to the detail of the Bill. There is no evidence that this has occurred.

So to inform the debate, let us understand what commissioning is. Put simply, it is about ‘what to acquire’. ‘How to acquire’ is the next consideration. There are many ways of how to acquire, ranging from competitions to grant aid and forming partnerships, employee-owned organisations and mutuals. No matter what route is chosen, it is public money whose spending is subject to value for money provisions.

Contracting is the inevitable backstop. With contracting, the contractee holds the right to determine the contract and most assets will be kept under public sector control. This is not privatisation, which is selling shares in a regulated business. This is nowhere near this agenda.

This demonstrates the problems of communication in this area, where people are unclear of the definitions and meanings. Indeed, where are the commissioning standards, regulation, guidance and examples of good practice, and why have the lessons of the past on commissioning not been learnt?

Since then, in order to clarify what commissioning is, the role has been defined in the National Occupational Standards. We would expect that GP commissioners should attain the National Occupational Standards; after all, they have to maintain clinical standards, so why not occupational standards?

In the new world, commissioners are required to take a strategic view and we applaud the efforts being made by NICE and SCIE to provide an evidence base for commissioners. The focus is now to learn from the experience of the past on implementation and how to embed this organisationally.

The recent clustering of PCTs has led to ‘Commissioning Genocide’, where much of the existing commissioning expertise has been removed. In addition, the Council budget reductions have also led to the elimination of commissioning roles in key councils.

We have been informed that encouraging commissioning professionalism is low down the level of priorities. How can an effective system be built without embedding a higher level of professionalism into organisations? The Health and Social Care Bill will require GPCCs to gain authorisation and to submit its Commissioning Plan. How many GPs have produced a Commissioning Plan? The clear focus is on authorisation, but where are the experienced clinicians who have produced a Commissioning Plan?

In order to safeguard the NHS, it’s time for clear leadership in this area. If commissioning skills are not embedded into the GPCCs, then the reforms will lack foundation and collapse. Commissioning genocide will only help if it is used to learn the lessons of the past and develop commissioning like other mainstream professions. This is a complex world where the detail does need to be fully thought through or else scarce resources will be wasted rather than being better used saving lives.

Doug Forbes is Director of the Institute of Commissioning Professionals, a not-for-profit member-owned organisation dedicated to improving commissioning standards.

The book, Achieving Commissioning Excellence, is available at: www.commissioning.org.uk

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