Sunday, 1 August 2010


The dividing lines on commissioning seem to be crystallising and viewpoints are now becoming clear. Hospital consultants like myself are very much watching from the sidelines, not disinterested, but not really involved. I don’t see that the changes are likely to affect us very much. In some places the PCTs seem to me to have too much power, and are even starting to dictate practice in secondary care, so I won’t be sorry to see them go. Ideally the new bodies should be the servants of GPs and not the masters. 

It does seem to me that most objections seem to focus around the involvement of the private sector. I think it important here to make a distinction between private health care provision, and private commissioning. If the former can deliver better value health care for whatever reason then I think GP practices should be free to contract there instead of with the NHS Hospital. An example of this is given here.

I would agree however that involving private companies in the commissioning process itself is a bad idea, will attract those with the wrong motivation, and will bleed resources out of the NHS.

The BMA predictably are fence sitting and as ever are unlikely to stir themselves greatly over this issue. It is hard to see how this process can be resisted and I still think that, rather than resist the whole idea, we are more likely to be successful if we concentrate our opposition on the worst aspects. 

I make an assumption, a suggestion, that if there was a commitment from government that commissioning bodies were not provided by the private sector, many GP’s would find the whole process far less unpalatable.

Am I wrong?

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