Last week was an historic one. Most people picked up that something seismic had happened, but weren’t entirely sure what, as enquiries came in from pharmacists to MPs to venture capitalists.
We had set out a prescription for success that we deemed necessary for the White Paper and in this and blogs to follow I will be picking up on the hits and misses. The first miss was that we recommended ditching the word ‘commissioning’, because it is a confusing term, encompassing a huge range of functions (buying, selling, planning, strategy, monitoring, evaluating, performance management, specialism appraisals, data collection, reconfiguration, IT systems) and GPs can’t do them all. (David Stout of the NHS confederation makes the same point). They can delegate, contract and sub-contract and that makes them more like Trusts or Authorities. Considering that their consortiums will now, to satisfy Treasury rules, have to become statutory bodies, “GP Trusts” or “Practice-based Trusts” are probably more accurate descriptions and less confusing too. However we made the correct assumption that GPs would certainly be put in the driving seat of the NHS.
And secondly we hoped that top down reorganisation of PCTs was not included in this Paper, and that their future could be determined by the gradual reshaping of the system that would be led by the GP consortia. We foresaw their attrition but thought that this sort of bottom-up evolution should be in keeping with the aim of less political, structural reform and more progressive, clinically led service development. The challenge will now be in keeping PCTs viable as some able staff jump ship as quickly as they can (to the independent sector ready and able to expand commissioning support) and all staff battle with morale as the PCT vessel gradually sinks.