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It's time to stop this NHS sell-off

GPs will face further curbs on their clinical freedom under plans to outsource NHS commissioning to private firms, warns Dr David Jenner

GPs will face further curbs on their clinical freedom under plans to outsource NHS commissioning to private firms, warns Dr David Jenner

As the Government's drive to increase the involvement of the private sector in the NHS gathers pace, I finds myself reminded of Roger Miller's famous lyrics...
NHS for sale or rent
Beds to let, 50 cents
No phone, no food, no pets
At least we don't do cigarettes! Ah but
Two hours of commissioning
And then four more of tendering – I'm a
Man of means by no means but
I am king of the old NHS!

Where is the evidence the NHS really is up for sale? In the summer of 2006, the Department of Health invited large corporations to express interest in joining a central list of approved providers who could be called on for the outsourcing of NHS commissioning. This list – known as the framework for external support of commissioning – is due to be published any minute now.

Next we see South Central SHA, led by chief executive Mark Britnell, award a £2m contract to PriceWaterhouse Coopers to inform his strategic commissioning plan. Mr Britnell then becomes DH head of commissioning and service redesign and Tony Blair appoints Channing Wheeler, recently departed from US giant UnitedHealth Group, as a commercial director.

In the same week Simon Stevens, former special health adviser to Mr Blair and now president of UnitedHealth Europe, claims practice-based commissioning cannot be the sole solution to commissioning healthcare. It seems outsourcing healthcare commissioning to private companies is a possibility, if not a probability, in the near future.

So what's the problem?
Is this a bad thing? There are, after all, many critics of PCT commissioning.

The key issue, though, is whether it is right for companies to profit from the allocation of healthcare resources and public monies. Admittedly, PBC offers practices incentive payments. But I doubt many private companies would offer much for £1.90 per patient (payable only on delivery of savings). And of course unless they make specific arrangements with practices they will not be armed with the intelligence gained from seeing 30 plus patients a day.

And are PCTs market-savvy enough to hold companies to account? There have been several instances where PCTs have encountered difficulties entering into tenders with large multinational companies. Often companies running independent sector treatment centres are being paid minimum sums for work they never actually do.

So what could privatisation of commissioning mean? Securing the savings that will mean profit for shareholders will require demand management, so it is likely GPs will face further referral assessment schemes and pre-approval of referrals. There will be strict rules on eligibility for treatments, without allowing GPs to be the advocates of an individual's needs. There will also probably be better contracting with secondary care services – but will companies mind if local services become unviable and hospitals are forced to shut? I personally doubt it. Finally, much of health interlinks with social care, which currently comes under the auspices of local government – surely we are not talking about losing local democratic influence over what is commissioned?

I can see a role for private companies in providing data and tools to help inform commissioning – after all, the track record of NHS IT systems is shameful – but the commissioning decisions themselves must remain in the public sector as long as heath is funded from taxation. If the Government is really convinced wholesale NHS privatisation is the way forward, let's see a referendum on the issue – and for England only. So many controversial reforms have been won by the votes of MPs from Scotland and Wales who are themselves protected from the consequences.

GPs may not be the best businesspeople, but they do hold the confidence of the public and professional accountability to the GMC. The commercial sector has only responsibility to its shareholders (who often lie overseas) to deliver a profit.

The Commonwealth Fund now rates the NHS the best health service of any of the large English-speaking countries. We did this largely without big commercial influence – so if it ain't broke, why fix it? How about spending as much money on supporting PBC as we have on Choose and Book and foundation hospitals? Then – surprise, surprise – commissioning might actually work better.

Dr David Jenner is a GP in Cullompton, Devon, and PBC lead for the NHS Alliance.The views expressed are his own and not necessarily those of the NHS Alliance

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