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Get rid of duplication

John-Lee Thompson on what needs to happen to save £20 billion

The reality of moving into a more austere period is starting to sink in. To save £15/20 billion pounds-worth of savings over three years and beyond is a opportunity to think both opportunistically and entrepreneurially about the way services have been delivered. Challenges to long-held beliefs should be welcomed and encouraged.

Commissioning PCTs can no longer ignore the positive benefits that can materialise by engaging with PBC.

Why do PCT's with a PBC Collaborative/body/entity also see the need to maintain a stand-alone commissioning directorate? Why can it not be subsumed into PBC where effective commissioning according to the health needs of the population can and arguably should be managed and delivered?

This model reinforces the original contention that clinicians should be at the forefront of commissioning (as originally planned). Further, it sends a clear and unequivocal message that management costs can be reduced and efficiency gains made from within the administrative structure of the PCT by reducing the duplication inherent in having two commissioning bodies in the same organisation. This might then lead to a re-examination of the costs that have been incurred as a result of the commissioner/provider split where once again management costs have increased exponentially as a result of one organisation evolving into two. Everyone seems willing to be easily convinced that the only effective way of managing these organisations is through two separate management structures. But is that true and was an alternative ever properly tested?

The bottom line is of course that perhaps the status quo will remain because PCT's continue to reinforce their status as the overarching and controlling organisation in much the same way that Strategic Health Authorities think their sole purpose is to exercise control over PCT's.

John is deputy director of performance at Milton Keynes PCT