Since the inception of the NHS, with a few brief exceptions such as fundholding, NHS commissioning has been either absent, passive or minimally effective.
Currently NHS services are largely dictated by powerful hospital providers who, using the fixed-price national NHS payment system, have had no incentive to use taxpayers' funds appropriately or provide customer-focused, high-quality care. NHS commissioners have lacked the ability to deliver high-quality care and failed to effectively engage with their patients and public.
The vast majority of the public don't even know what a PCT or SHA is, or what these organisations are supposed to do, or who runs them. Bureaucrats have been making decisions about, and for patients through the decades with little understanding of what patients want, need or expect from the NHS.
GPs, who provide 90% of all NHS contact with the public, do however, have a close and detailed understanding of both individuals' needs and those of the broader population. However, they have for too long been placed in the impossible position of helping patients navigate an NHS system which has developed more by accident than design; by hospitals and commissioning NHS managers, not clinicians.
The White Paper proposes that clinicians and patients determine together the quality and extent of healthcare that the NHS should provide, and effectively design the system around the patient. England has the opportunity to create an NHS that is clinically cost-effective, designed around peoples' needs and ‘customer'-focused.
GP commissioners are the best hope of ensuring the country's financial problems are an opportunity to improve healthcare, rather than a risk to the NHS's viability.
Drs Ranjit Gill and Charles Alessi
Executive Members, National Association of Primary Care (NAPC)
