By Stuart Gidden
GPs should not be able to take on commissioning control themselves, but should work alongside a range of secondary care professionals and health experts, a cross-party committee of MPs has warned.
The Commons Health Committee report, published today (5 April 2011), calls for "significant changes to the Health and Social Care Bill", including renaming GP Commissioning Consortia as 'NHS Commissioning Authorities' to reflect a wider base of decision-makers.
The report places further pressure on the government to amend the Health Bill, following Health Secretary Andrew Lansley's admission yesterday that he is faced with "genuine concerns" about the direction of NHS reform, and will delay its implementation to allow time for further consultation.
The Health Committee report, welcomed as "forensically accurate" by the NHS Confederation, argues that commissioning bodies be put under greater scrutiny and be made more accountable to local authorities.
It recommends that commissioners be given a legal obligation to consult HealthWatch, the new patient involvement body in England, and that HealthWatch in turn should have a legal duty to consult with patients.
Its most significant recommendation is that representatives of nurses, hospital doctors, public health experts and local communities should all be involved as decision makers alongside GPs in commissioning groups.
They believe this is vital if the NHS is to meet the "unprecedented challenge" of finding 4% annual efficiency savings over the next four years.
Committee Chairman Stephen Dorrell, a Conservative MP, said: "We believe it is crucial to get the reform of NHS commissioning right if the service is to confront the massive financial challenge it now faces.
"Our proposals are designed to ensure that NHS commissioning involves all stakeholders – GPs, certainly, but also nurses, hospital doctors and representatives of social care and local communities.
"We believe this broadening of the base for commissioning is vital if we are to achieve the changes necessary to allow the NHS to deliver properly co-ordinated healthcare."
In response to the report, Chris Ham, Chief Executive of The King's Fund, said: "As the Health Select Committee has made clear, modifications to the Health Bill are needed if the government's health reforms are to succeed.
"Reform is necessary, but it should be based on a staged approach to implementation, a clearer understanding of where and how far to extend competition, and clearer lines of accountability than those currently proposed in the Bill."
The Health Committee's proposals would remove the need to separate the commissioning of primary and secondary care, as currently proposed.
Mr Dorrell said: "Ever since 1948, the NHS has suffered from an artificial distinction between primary and secondary care.
"Instead of entrenching this distinction further, this is an opportunity to abolish it for good – and create a single, integrated health service which is able to provide properly co-ordinated care to all patients."
This point was disputed by Nigel Edwards, Acting Chief Executive of the NHS Confederation, who otherwise welcomed the report.
"We absolutely agree with the committee's view that the accountability of GP consortia must be radically improved. We need a comprehensive and clear governance structure that has the confidence of patients and the public," said Mr Edwards.
However, he added: "The proposal for fully integrated commissioning of primary, secondary care and social care is a radical idea with lots of potential.
"One of our worries with the reforms is the potential for conflict of interest among GPs where they are commissioning services that they also provide. This could be even more of a concern if the Committee's proposal was implemented."
Mr Edwards also raised concerns about the Committee's recommendation to put local politicians on consortia boards, which he described as "completely contrary to the government's rhetoric about removing politics from the NHS.
"There are very few questions to which the answer is 'more politicians'. We're all for more scrutiny of GP consortia decisions but there is a point where political involvement becomes unhelpful to the running of an organisation."
The government has announced plans for a "listening exercise" about the NHS reforms. Details are to be sent out later this week, but it is expected to involve both the prime minister and the deputy prime minister.
Do you agree with the MPs' report? Do GPs need greater help with commissioning than the Health Bill proposes? Your comments (terms and conditions apply):
Is that not why we have practice managers? It is risible to suggest involving local councils etc if they are like the local council we have to deal with. They are in chaos and making cuts all over the place. Social services are likewise making cuts and try to bounce anything even remotely medical back to primary care and why exactly do hospital Drs need to be involved? Do they have expertise in management - no they have less knowledge in my experience than GPs. I am happy to involve patients if they would take an interest but I find this idea that everybody else knows better than GPs offensive to say the least" – Name and address withheld