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From passive to active commissioner

Our GP blogger, Dr Clive Henderson, ponders how things have changed from when he was on the sidelines giving a general practice slant on commissioning matters.

Pathway redesign is a laudable objective but fraught with difficulty.

It is however one of the few mechanisms for cost reduction, given the veto on cost competition as well as improved quality and bringing the service out to the community.

When volunteering -actively or passively -to contribute to the process there are a few caveats.

One of these is that one can soon move from a benign contributor, giving a general practice slant on things, to a rather more conflictual and statutory role.

The creep from beneficently spreading your pearls of wisdom soon begins when evidence base is called for. Then you find yourself looking at which guidelines apply and what interpretation of those to adopt , bearing in mind these are open to challenge by all and sundry.

An early example was trying to unpick whether a former consultant dermatologist was eligible to do skin cancer work , beyond low risk basal cell cancers, if no longer employed by an NHS Trust.

The next issue is soon you may find your name bandied about as the lead GP for your area of reform and after the glow of self importance fades, the reality of being culpable if things go pear shaped begins to dawn.

Much discussion with primary and secondary care colleagues, patients, users , abusers, clients needs to be had. We have to make sure all possible discrimination is considered and mitigated and that your shiny new algorithm does not pose unforeseen consequences to existing services.

The next caveat is a lot can happen between ‘finishing' your clinical bit and a service beginning. Contracting, procurement and contract monitoring may well be somebody else's job but when the excrement hits the fan it is hard to use them as an umbrella.

I recently found an MSK pathway heading in a different direction than expected with a veto being placed on any patient phone calls to physiotherapy and complaints from providers that a premature suspension of current service was open to a legal challenge I had not been party to these discussions but I was the one being asked the questions.

Likewise, a large PCT's ‘invest to save' speculative risk seemed about to happen when my perception was that we had a fair amount of power to persuade putative providers that they should bear the risk , not us.

Do take part in pathway reform but just be sure to check if you are contributing or leading, and if the latter, then the job's not done until the new system is up, running and shown to work well.

Dr Clive Henderson is a GP and chair of Goole, Howden and West Wolds locality commissioning group

Dr Clive Henderson