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My three commissioning wishes

What does the new Government need to deliver on commissioning? Alisdair Stirling asked PBC experts for their three wishes

What does the new Government need to deliver on commissioning? Alisdair Stirling asked PBC experts for their three wishes

Dr Tony Brzezicki, vice-chair of the Pan-Croydon PBC group and a GP in Croydon, Surrey

1. A positive attitude in the NHS

I'd like to see the culture of the NHS change to a ‘can-do' rather than an ‘if-but' organisation. The NHS has evolved in complicated ways, so there's a lot of brilliant work being done all over the country but it's difficult to replicate nationally.

2. Clinical leadership in the health service

There's a lot of talk about clinician engagement and PCTs sometimes pay just lip service to this. I would like to see actual clinical leadership where the management structure of the NHS ensures that care is delivered where and when it is needed.

Clinician-led care always produces good results but currently only on a piecemeal basis. We need it to be part of the fabric of things nationally.

3. Support for good practice

We need the NHS to support clinicians, not use them as political footballs. PMS, new GMS and other reforms were all imposed on GPs. But now we have a chance to reward GPs for good practice. PCTs and health authorities have the power to manage poor performance but fail to do so. We need a carrot and stick approach and to ensure practices at the bottom, in terms of performance, are disbanded or made to improve so they don't drag others down.

I'll know my wishes have come true when:

• there is a revolution in GP-led commissioning

• rewards for good practice are better

• there are fewer PCTs

Dr James Kingsland, NAPC president and national PBC clinical network lead and a GP in Merseyside

1. Hard budgets

These would give us more ownership, so that the decision-making on how NHS resources are deployed could be made at practice level. Accountability allows us to manage. Lack of hard budgets has held back our progress so that PBC has only been able to develop in pockets and in a piecemeal fashion so far.

2. Fair-share budget-setting

We need rapid development of a ‘fair-shares' approach to budget-setting – or an accurate formula that gives a fair reflection of the population's needs. Most GPs would take on a commissioning budget if they knew it would really give them a fair share for their patients.

3. Save the NHS

If we got the two wishes above, we could use them to transform services and save the NHS. I wouldn't want to be outlandish in what I ask for. But the problems we have aren't going to go away and giving us the tools to do the job seems reasonable.

I'll know my wishes have come true when:

• there is a white paper (which preferably should come out soon) that facilitates these wishes

• we see rapid acceleration of PBC

• real progress is made towards clinician-led commissioning

John Lee-Thompson, deputy director of performance at Milton Keynes PCT

1. A commitment to outcome-based commissioning

There is no evidence that politically driven targets improve care. What we need from the new Government is a commitment to proper outcome-based commissioning.

The new health secretary, Andrew Lansley, has every opportunity to bring in a radical reform agenda. Let's have a health secretary who has a passion for commissioning for outcomes and gets on with a real transformation of the NHS.

2. Complete integration with the private sector

I don't see how we can be a national health service if we regard the private sector with suspicion. Where would we be without what pharma has invested in new drugs? They could sponsor anything from PBC consortiums to mental health trusts. Why not have a Microsoft NHS Trust or a Happy Valley Community Health Service? We have these corporations waiting to be offered an opportunity. Why not give it to them?

3. Better relations between the Government and GPs

The Department of Health has alienated clinicians with mismanagement of consultants' contracts and the GP contract. If we're going to have GP commissioning, we need fewer bureaucratic restrictions. The evidence is that GPs actively promote change and PBC gives them that opportunity. We need to stop squabbling.

I'll know my wishes have come true when:

• outcome measures are enshrined in the new GP contract

• there is a period of political and administrative stability

• GP partnerships are made with Apple or Microsoft

Dr Niti Pall, member of the PBC clinical network and a GP in Sandwell, West Midlands

1. Commissioning freedom for general practice

I would like to see GPs given the freedom in all make-and-buy decisions with the least possible fuss. We need to be given room to make these decisions ourselves.

2. Outcome-based delivery

Whatever budgets we do get, they have got to be for population health management. There have to be strings attached – not just managing the budget. I would describe this as outcome-based delivery. And it has to be a long-term contract.

3. Remove the clinician barriers

You have to allow the clinicians to engage with each other without barriers in order to provide the best possible care. We should be aiming for socially minded HMOs that allow clinicians to get together to organise care the way they see fit. Let a thousand flowers bloom!

I'll know my wishes have come true when:

• there is a GP contract that includes resource management

• GPs who want to run with it are allowed to do so

• practices that don't make changes are in danger of being left behind

Julie Wood, director of the NHS Alliance clinical commissioning federation

1. Keep up the momentum

I want PCTs and PBC groups that weren't able to make progress over the past few years to be able to make it under the new Government.

We desperately need to maintain the momentum that has built up in PBC and to spread it to other areas. There are good omens in what the coalition are saying and we really need now to see what's on the table.

2 More integrated working

I would like to see the system we create allowing clinicians to work together across different settings, particularly primary and secondary care.

This might mean moving care from the secondary sector into primary care where necessary. There have, in the past, been perverse incentives to prevent this happening. These need to be discarded.

3. Empowering GP commissioning

I want to see GP commissioners being able to get on and make the right decisions for their practice populations.

We need a system that can cope with the pace of change – to reignite the fire in the bellies of clinicians. We need good clinical governance, but governance has, in the past, been disproportionate. We need a system that allows quicker change.

I'll know my wishes have come true when:

• clinical leadership has a bigger role

• GPs create the solutions to the problems they encounter

• the pace of change increases

Dr Nav Chana, vice-chair of the NAPC and a GP in Mitcham, Surrey

1. Focus on population health

I would like to see a shift towards healthcare being directed at the practice population as a whole rather than just the patients who walk into your surgery. In many ways it's the same as public health, with a focus on smoking, obesity and promoting wellness.

I'd be looking for a high-level agreement with some hard outcomes – and then I'd like the organisation to deliver that to be left to us.

2. Integration of health and social care

Health and social care are artificially separated at the moment, though the two domains are actually intertwined. They are financed from two separate pots and that should be changed so they are dealt with together.

3. Real adjusted capitation budgets for GPs

In many ways this pulls the first two wishes together, taking what PBC has done further and empowering GPs. The real budgets need to come with real incentives.

I'll know my wishes have come true when:

• capitation budgets are real

• primary care is empowered

• divisions between health and social care are eroded

Alisdair Stirling is a freelance journalist

Dr Tony Brzezicki

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