THE Tory-Lib Dem coalition government’s White Paper on the NHS contains plans for sweeping changes.
NHS Commissioning Board The sole commissioners for the NHS will be the NHS Commissioning Board and approximately 500 GP Commissioning Consortia. These will control around £80bn of the £100bn NHS budget.
As they will control the purse strings and enforce the contracts, they will dictate the cuts to care, the configuration of services and distribute contracts to private companies in line with the ‘patient choice’ remit.
An ‘autonomous NHS Commissioning Board’ will be handed control of the NHS and will be answerable to the Secretary of State for Health. The members will be appointed not elected and it will report only annually to Parliament.
• It will have enormous powers.
• It ‘would have the power to restrict the scope of the services provided by the NHS’, i.e. could decide to withdraw procedures and limit NHS care to so-called ‘core services’.
• It will allocate and account for most of the NHS budget and keep within revenue limits, i.e. it will transmit the cuts.
• It will decide the structure of tariffs.
• It will commission some national and regional services, GP services and maternity services.
• It will establish a system of GP consortia and all GP practices must join one of these.
• It will calculate practice level budgets and allocate these to GP consortia and not allow overspends.
• It will performance manage GP consortia,and check on their commissioning.
• It will design model contracts for the GP consortia to use when commissioning with providers.
• It will set standards for NHS commissioning and procurement
• It will hold them to account for delivering satisfactory outcomes for patient care.
• It will promote ‘Patient Choice’, that is care from private providers, and promote patient budgets.
• It will encourage what the DH calls ‘good practice’, for example maximising day care surgery in hospitals, and enabling community access to care and treatments, i.e. it will promote reconfiguration of care out of hospitals.
• It may have outposts in the regions.
Secretary of State for Health
• The Health Secretary will have much less power than at present to decide the running of health services.
He or she will maintain powers to develop national strategies and determine what services should be provided. He or she would have powers to arbitrate on reconfiguration of services with regard to ‘failing’ hospitals, etc. He or she would give a mandate to the National Commissioning Board, probably for three years, instructing it to keep financial control and expand ‘patient choice’, i.e. care from private providers.
Every GP practice will have to join and contract with a GP commissioning consortium, which will hold them to account. These consortia will be responsible for budgets allocated by the NHS Commissioning Board.
These GP commissioning consortia have to purchase hospital care and community care in their areas, supposedly in partnership with other health professionals, local communities, and Local Authorities.
Consequently, as the resources allocated to them by the NHS commissioning Board will be inadequate, given the reduction in national funding, the GP consortia will have to decide which services to commission and which they will not. In effect the GPs will be given the responsibility to decide what to cut.
The hospital closure programme pursued by the PCTs at the behest of the Labour government will fall into the lap of the GPs. The GPs will be told that PFI buildings have to be paid for and that there is not the money to commission some treatments.
The White Paper calls this healthcare being run from the ‘bottom up’. A truly poisoned chalice!
The role of the GP would be different from what it is now. The main role of most GPs is to provide healthcare to their patients. The new proposals would involve a change to the GP contract, to make it mandatory for GPs to take on a commissioning role as well as a medical role. Such a change of contract would need to be negotiated with the British Medical Association (BMA).
These GP consortia will have to ‘have sufficient geographic focus to take responsibility for agreeing and monitoring contracts for locality based services (such as urgent care services)’.
It has been estimated that around 500 GP Commissioning Consortia, would need to be created with patient populations of 30,000-100,000.
The White Paper says: ‘GP Consortia will have the freedom to decide what commissioning activities they undertake for themselves and for what activities (such as demographic analysis, contract negotiation, performance monitoring, and aspects of financial management) they may choose to buy in support from external organisations, including Local Authorities, private and voluntary sector bodies.’ (p29)
Many GPs will not have the training or inclination to do contract negotiation, or accounting, and therefore private companies will end up being bought in to do this work.
A report by the Kings Fund senior researcher, Chris Naylor, said that giving commissioning responsibilities to GPs would ‘amplify’ the ‘trend’ established under the previous administration, which invited private companies to support NHS commissioning through schemes like the Framework for Procuring External Support for Commissioning (FESC). Companies involved included McKinseys, McKesson, Humana, Tribal, UnitedHealth.
A survey showed that 89 per cent of PCTs used external support in 2009, with 40 per cent of this support coming from private companies. (Pulse 2.7.2010)
No doubt the NHS Commissioning Board will contain appointed friends of the new Tory-Lib Dem government in the form of academics, health officials and representatives from the big multinational health companies.
This is the way it has worked in the past. The erstwhile Chairman of NHS London was Sir Richard Sykes, who had been Chairman and Chief Executive of Glaxo, a pharmaceutical corporation. The end result will be commissioning by private companies for private companies.
This is like putting dracula in charge of the Blood Transfusion Service!
Health Secretary Andrew Lansley used the phrase ‘No decision about me, without me’, when referring to patients. The coalition government is ensuring that, as far as the private healthcare corporations are concerned, there will be ‘No decision about me, without me’!
Concluded tomorrow
