Now, as a draft consultation document, but from April 2013 to the end of March 2015 once it has been confirmed.
What is it?
The document lists 22 objectives for the NHS Commissioning Board that derive from the central policy aims of the Health and Social Care Act. The mandate confirms that the board is accountable to the secretary of state for healthand its place in the wider health and social care system. In this respect, the document is what you might expect.
It’s also meant to be the charter for the NHS Commissioning Board, a mission statement that clarifies its role and relationships with other parts of the system, removing ambiguities and settling nerves. In this respect, the document is a disappointment.
It touches on a few, including the hotly debated issues of practice boundary reform and choice of provider.
We know already that ‘your GP, dentist or optometrist must offer you a choice of any provider when referring you to your first consultant-led outpatient appointment’ and that ‘if they do not, your primary care trust – or from April 2013, your CCG or the NHS Commissioning Board – must make arrangements to ensure that you have a choice’.
For anyone looking for a softening of the line on choice, the mandate makes a nod to the NHS Future Forum’s recommendations when it says that ‘choice should be pursued where it is in patients’ interests and not as an end in its own right’.
In all honesty, not much. The mandate has much more to say about the wider responsibilities of the NHS Commissioning Board for spending its share of the NHS commissioning budget (about £20bn) and about its relationship with CCGs, who will control the rest, than about the relationship between the board and general practice.
Why it matters
The mandate is important because it will set the long-term direction of one of the most important agencies in the new system’s architecture.
Although the next version will be up for review in April 2015, with potential further revisions after that, the mandate will form the basis of a 10-year plan.
The mandate restates the policy intention of ‘putting clinicians in the driving seat and enabling healthcare providers to steer improvements in quality’, a carefully worded phrase that conveys the hope general practice will sort out its own quality issues without ruling out the threat of intervention.
The mandate also repeats the promise of ‘an NHS liberated from day-to-day top-down interference in its operational management’, but the NHS Commissioning Board is also there to ensure that while primary care clinicians are leading the new commissioning system, primary care itself is also being managed.
Four documents, including the NHS outcomes framework and a choice framework, are appended to the mandate. These will be used to measure the NHS Commissioning Board’s objectives and assess the ‘care results’ of the organisations it commissions.
What is still not clear is how individual practices that fail to meet the objectives of choice, access, safety or any of the other standards of care will be managed in the new system, and where support from CCGs will end and accountability to the NHS Commissioning Board through its local area teams will begin.
Apart from ‘care results’, there are ‘other important objectives that are not outcomes, but that the Government will want to set’. Knowing what these other objectives are would be useful, but the mandate doesn’t say.
A question that appears to be answered but is not is about the respective roles of the NHS Commissioning Board and CCGs in commissioning services as an alternative to hospital care. Many of these are existing enhanced services. The mandate simple says ‘CCGs are not responsible for commissioning primary care’, which leaves a few doors open.
If you only learn one thing…
This is very much a first draft that sticks to safe, well-trodden ground and sensibly avoids the boggy regions. One of the five consultation questions is: ‘Are the objectives right? Could they be simplified and/or reduced in number? Are there objectives missing?’
The one takeaway lesson is that, however sceptical you feel about the reforms or the consultation process, there may still be an opportunity to shape the board’s job description.
Where this matters most for general practice is around the detailed questions of accountability and management of primary care performance, where the agenda is not so much hidden as still very much in draft form.
Helen Northall is the chief executive of Primary Care Commissioning