GP commissioning will not in fact be GP commissioning.
This was brought home in a Channel Four news item on Monday night which publicised GPs’ concerns about the government’s new guidance on ‘GP commissioning’.
The Department of Health (DH) has produced a document called ‘Developing Commissioning Support Towards Service Excellence’ in which it becomes plain that GPs will not be doing the commissioning themselves.
Instead, their role is to be handed over to private commissioning support companies.
The programme pointed out that a key selling point of the coalition government’s Health and Social Care Bill was the pledge that family doctors would be in charge of the bulk of the NHS budget and would buy all the care for patients in England.
Jonathan Tomlinson, an East London GP interviewed in the programme, said that the new document made clear that GPs would be commissioning almost nothing, just some services for patients with learning difficulties and some other small community services. The vast bulk of the commissioning would be done by the private support companies – needs assessments of local populations, choosing and designing the services they need, managing the contracts and monitoring quality.
The document clearly suggests on page 14 that the private support companies would ‘Support for Redesign’ and would be involved in ‘Identifying best value providers to respond to service needs’ and do the contract managing, tendering and negotiation.
Many GPs are becoming aware that this means that these private companies will be the ones deciding where patients will be treated, and could decide whether or not to allocate contracts to local hospitals.
Clearly the Health Bill gives private commissioning support companies a key role in diverting patients away from NHS hospitals and into private sector-run clinics and treatment centres.
The Hinchingbrooke deal, in which a private company, Circle, was allocated £1bn to take over the management of an NHS district general hospital for 10 years, represents the direction of travel under this government. David Cameron said at the time: ‘I want to know how we drive the NHS to be a fantastic business for Britain.’
This issue was discussed at the BMA’s GP committee last week and will come up at the BMA Council executive on Thursday.
Given that campaigners pointed out from day one, that a key aim of the Health Bill was to privatise commissioning and bring in the big multinationals like UnitedHealth, KPMG, and McKinseys to take control of the bulk of the NHS budget in England, the reaction of the BMA, if it happens this week, will be very belated. Up until this point, the official position of the union is that it supports GP commissioning under the Bill as giving more clinical control.
Anna Athow, a member of BMA Council speaking in a personal capacity, said ‘It is important that the Bill’s real aim to hand over the bulk of NHS money to private commissioning support companies has been publicised on a mainstream news programme at last.
‘The talk of clinical control was always a fairy tale to confuse the public and sections of the medical staff. Once these companies get control of the £60bn GP budget, privatisation will let rip in the new market opened up by the Bill.
‘Scores of NHS hospitals will face closure in the drive for “redesign”. It is long overdue for BMA Council to take a stand and oppose the Bill in its entirety.’