MPs call for GPs to share commissioning responsibility

By Gareth Iacobucci

MPs have urged the Government to radically rethink its plans on NHS reform, including replacing GP consortia with new 'commissioning authorities' involving secondary care doctors and local politicians.

The House of Commons Health Committee has called for GP consortia to be re-modelled as 'NHS Commissioning Authorities' to reflect the importance of other sectors such as secondary care, public health and local authorities in commissioning healthcare alongside GPs.

The proposals to abandon the concept of ‘GP consortia' are the latest blow to the Government's NHS reforms, with the health secretary Andrew Lansley forced to make a statement in Parliament yesterday to underline that he will be listening to concerns over the way the health bill will be implemented.

MPs also called for the re-shaped organisations, which they say should effectively operate as local representatives of the new NHS Commissioning Board, to assume responsibility for commissioning the full-range of primary care, including general practice.

The committee calls for a staged implementation of commissioning changes rather than a ‘big bang' approach, and for PCT clusters to be retained as outposts of the NHS Commissioning Board beyond 2013 so that their resources can be used to help support new arrangements.

The report, Commissioning: Further Issues, makes a host of recommendations to the Government on areas to revise, including abandoning the term GP consortia, which it claims has led to the perception that GPs would be the only ones involved in commissioning.

It says: ‘It is important to recognise that effective commissioning requires a balancing of often conflicting objectives, and that it is profoundly unhelpful to allow the perception to develop that the commissioning function is a GP preserve.'

‘The Committee, therefore, proposes that the new local commissioning bodies to be created by the Health and Social Care Bill should be referred to as NHS Commissioning Authorities.'

The report says places on the local commissioning boards should be set aside for nurses, secondary care doctors, social care representatives and elected members nominated by local authorities to sit alongside GPs.

The committee also calls for proposals to establish separate Health and Wellbeing Boards to be dropped, with responsibility for Joint Strategic Needs Assessments and Health and Wellbeing strategies instead shared jointly by the new commissioning authorities, local authorities and Public Health England.

It also said the ‘lack of power' on the part of Local Healthwatch to request information from commissioners was currently a ‘deficiency which should be corrected', claiming commissioners should be ‘under a duty to consult Healthwatch when making decisions about service provision'.

It says these recommendations – as well as stipulation that all boards must meet in public - would strengthen the governance of the new organisations and remove the need for primary care to be commissioned separately.

It says: ‘Arguments for the complex arrangements set out by the Government fall away if our proposals for significantly strengthened governance in NHS Commissioning Authorities are accepted.

‘Given this, the Committee recommends that NHS Commissioning Authorities should assume responsibility for commissioning the full range of primary care—including services such as pharmacy and dentistry as well as general practice—alongside their other responsibilities.'

Nigel Edwards, acting chief executive of the NHS Confederation, said the report was 'forensically accurate' in the problems with the Government's plans, but warned having elected members on the authorities would introduce more politics into 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,' he said.