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Is your CCG an Apple or Microsoft? (and I don’t mean your IT system)

As commissioners we have some big strategic decisions to make, the biggest is Apple or Microsoft? I'm not talking IT systems, but strategy. Apple has always maintained an end-to- end approach, controlling and owning every step of the process, preventing the user from a substandard experience. Microsoft on the other hand has licensed their product, opened the platform and allowed anyone to develop programs that run other Windows system. 

In health commissioning terms we have the same choice. Open up competition on a standard the CCG sets and let the market deliver, or control the platform, provide the services and ensure the service responds to a changing demand. 

Both models have strengths, but the weakness is in blindly mixing the models, competition for some things, own provision for others. Sadly the shift to primary care offers a tempting chance to provide services within traditional practices but unfortunately anyone thinking of this must realise GPs are still in Steve Jobs garage dreaming of building Apple Corps. We have decades of development before we too can provide integrated end-to-end service in all clinical domains. Our best plan is to integrate our existing providers, own our standards, pulling in new partners when required to force the pace of change, but keep the old businesses onside. This approach should change the game sufficiently to disrupt the old ways while controlling the ensuing chaos, and shaping a system worth having.

Dr Chris Mimnagh is a GP in Kirkby, Knowsley and director of strategy at Aintree University Hospital Trust