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We're engaged - now what?

NAPC chair Dr Johnny Marshall on what needs to happen to put clinicians at the heart of commissioning

NAPC chair Dr Johnny Marshall on what needs to happen to put clinicians at the heart of commissioning

Last month, I went on a two-day event organised by the Department of Health to discuss how to reinvigorate practice-based commissioning. Everyone in the room – from the policymakers to the clinicians at the coalface – agreed that putting clinicians at the heart of commissioning achieves the best outcomes for patients. The international evidence supporting this is overwhelming.

The danger at the moment is that there's a focus on clinical engagement in commissioning without fully understanding what this means. Announcing an engagement often results in little change within a relationship. It is not until the marriage that things really begin to change.

To make the partnership between clinicians and PCT managers work in commissioning requires three key ingredients. Clinicians need to have power and influence, clinicians' leadership skills need to be highly developed and the PCT must supply the necessary support to PBC.

Resources and incentives are needed to free up GPs, and other clinicians, to get involved in the commissioning process and they need to feel their clinical opinion actually influences commissioning decisions. This power and influence should rightly sit within a partnership of equals between managers and clinicians, between the PCT and PBC groups.

This is more likely to happen if the commissioning aims of the PCT and PBC group are aligned. So an understanding of the ambitions of each needs to be fully understood by the other.

A good clinical leader needs the skills to commission and to win the trust of those who are going to hand over the power and influence. It requires leaders who are good at getting people to change how they work, leaders who are good at providing expert knowledge to support service redesign, leaders who are good at auditing, monitoring, constantly improving services, education and training.

There is a need to develop not only our current clinical leaders but future clinical leaders, too. And this too will require resources to free people up from their day jobs and support them in accessing high-quality leadership training.

Effective PBC relies on the support of PCTs for it to develop and flourish. This includes health needs assessment data, indicative budgets, activity data and analysis and resources to support project management. In some PCTs that's just not happening.

What's needed is a mind shift where PBC is seen as a customer of the PCT to whom it is providing these services. There needs to be formal agreement about the support a PCT is providing to a PBC group and if ultimately that support is not forthcoming from the PCT, the PBC group should be able to commission that support from elsewhere. The alternative ‘supplier' might be another PCT or a private provider.

Involving clinicians in commissioning leads to better outcomes for patients. There is a need for a change in mindset from both PCTs and practices if they are going to forge a powerful partnership to deliver the changes within the NHS that its patients deserve. Unless that change occurs at PCT and practice level first, I doubt much will change.

Clinicians need power, skills and support to be effective. If the PCTs cannot provide this, how much longer can the NHS wait? If the PCTs can provide this, are the clinicians ready to step up to the plate?

Dr Johnny Marshall is NAPC chair and a GP in Buckinghamshire

Dr Jonny Marshall, chair of the NAPC Dr Jonny Marshall

Clinicians need power, skills and support to be effective. If the PCTs cannot provide this, how much longer can the NHS wait?

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