Commissioning

Keeping the status quo is not an option

If the NHS is to survive one of its toughest financial challenges yet, the coalition government needs to move quickly towards clinically led commissioning, says the NHS Alliance.

Developing GP Commissioning - a new form of local clinically led and empowered commissioning, a paper published by the NHS Alliance, argues that partnerships which allow clinicians, in both primary and secondary care, as well as managers, to work together to take ‘make or buy’ decisions could pave the way towards a truly integrated and patient-centred NHS.

GP commissioning, a model that involves a wide range of clinicians and managers working in a co-operative local clinical partnership, is the solution to a health service facing one of its toughest financial challenges yet, says a paper by the NHS Alliance.

The GP commissioning model – which encourages co-operation, not competition, between care sectors through an associated payment system that supports radical service re-design and delivery – would see profits ploughed back into patient care, hence creating a more efficient health care whose main interest is meeting patients’ needs.

This new model would enable local ownership and accountability, local clinical leadership, innovation and attention to local patients’ needs. And, while GPs would take responsibility for commissioning, there would be flexibility for them to decide the level of direct involvement and then be able to delegate part of that responsibility upwards to a clinician-led commissioning group or clinical partnership.

There is no one-size-fits-all approach as this model is pretty much about meeting local needs through local solutions. Partnerships would be forged within a locality to handle risk and ensure accountability, not only for the budget but also for commissioning outcomes and patients’ experience.

Dr Shane Gordon, National Co-Lead, Clinical Commissioning Federation, NHS Alliance, comments: “This courageous shift of policy will bring GPs to the forefront of NHS leadership. There are challenging times ahead and a delicate balance to strike between local focus and strategic priorities. It is vital that we form strong partnerships between expert clinicians and talented managers to secure the future of the NHS.”

Julie Wood, Director, Clinical Commissioning Federation, NHS Alliance, said: “This resonates with the government’s policy, but now it’s time to act. The government needs to move quickly and work closely with those ready to take this model forward.”

According to the NHS Alliance paper, some advanced PBC consortia may be ready to pilot full budget holding, including current acute/PbR spend as well as primary care, ambulance, community services budgets. The paper emphasises that “the pace and scale of change required needs bold and radical thinking. Maintaining the status quo or seeing this as an optional extra, as the current PBC policy was clearly viewed by a significant number of health communities, is simply not good enough. Our patients, quite rightly, expect us to rise to the challenge and the NHS survival through the turbulent times ahead depends on it”.

Co-operative model – key features

GPs take responsibility for commissioning healthcare within an agreed resource envelope;
Hard budgets at locality level;
Clinicians are able to ‘make or buy’ decisions;
Co-operatives to work across primary and secondary care,
Real accountability for delivery against targets, priorities, quality, population health outcomes and budgets.

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