Commissioning: Out of the car crash and stuck in a traffic jam

I am shortly about to move from PCT Medical Director to FT Director of Strategy and Innovation, not surprising therefore that I support the concept of cooperative commissioning.
The idea of getting clinicians to agree, not just pathways, but approaches to the challenges we face seems to be the only way to resolve the NHS Nicholson Challenge.
One caveat, we must include the social care landscape more fully in our cooperation, since they do not exist in isolation from "clincians"

We just did exactly this for diabetes on the Isle of Wight by clinical collaboration.

A useful approach from Dr Fisher. What I also wonder about market 'plurality' and private providers, is who is really carrying the risk? When a private provider goes bust (and the more private providers are in the health market the more common this will be even if most are well run) the state is highly unlikely to brook turfing patients out on the street; take the example of Southern Cross, and when things go wrong in individual treatments in the private sector people get transferred back to the NHS. As I see it this means it is impossible to transfer the risk to an organisation external to the NHS. If the state still has to carry the can (and it does have to), then what is paid to such a provider should reflect this more accurately. I suspect that this would not lead to viable contracts and this is is a major flaw in what is proposed by government.