It is surprising how many colleagues, in both clinical practice and NHS management, consistently tell me that they could have easily enacted the necessary changes for commissioning within the planned NHS reforms without primary legislation. This only serves to reinforce how much misunderstanding still abounds and that so much of the narrative behind the reforms has been lost or forgotten.
Primarily, a change of law is required to allow clinicians, in particular the referrer, which more often than not is the GP, to be fully accountable and in control of NHS funding.
Commentators who expound the idea that it would have been so less complicated to simply involve more clinicians in current management structures seem to have selective memory loss. Previous attempts to give health professionals a greater say in the decisions of PCTs clearly did not work.
Clinicians make tough decisions every day, in most consultations in every clinic or surgery. It is this decision-making process that is now required to improve value as well as quality within our NHS. Simply trying harder at what has previously failed is not an answer and this is not the time to lose nerve by revisiting bygone arguments.
Commissioning must drive clinical change and this is best achieved by giving clinician the tools to do this….the most important of which is a hard budget.
We now need an NHS that is shaped by the people who have responsibility for performing the service and those who receive the care. This legislation specifically delivers that ambition.
Dr James Kingsland OBE is senior partner at the St Hilary Brow Group Practice, Wallasey, Merseyside, National Clinical Lead, NHS Clinical Commissioning Community, and president of the NAPC