The plethora of new bodies introduced by the Government to oversee consortia decision-making will increase bureacracy and may become the ‘tail wagging the dog’ of commissioning groups, warn top GPs.
Among the changes announced by the Government yesterday to the health bill, a number of new bodies will be established to advise and participate in commissioning decisions. They include ‘clinical senates’ involving hospital doctors and other professionals, ‘health and wellbeing boards’ involving local councillors and local arms of the NHS Commissioning Board.
These new bodies have been introduced to pacify critics of the health reforms, but have provoked warnings from GP commissioning leaders that they will stifle decision-making.
Speaking at the Commissioning Live conference in London today, Dr Shane Gordon, co-clinical lead of the NHS Alliance’s GP Commissioning Federation and GP commissioning lead for NHS East of England, warned these new satelitte bodies could have a lot of power over GPs in clinical commissioning groups.
‘Clinical senates’ make-up and how you select people for it is absolutely critical.’
‘A big concern from this are the number of interested parties who now have a veto of authorisation of consortia. The people whose system they could change. Clinical senates, NHSCB, and Health and Well Being Boards. The other is the potential for clinical senates to become the tail wagging the dog.’
Dr Nigel Watson, chair of the GPC commissioning and service development subcommittee, echoed these concerns saying that a ‘clinical talking shop’ must be avoided.
‘What we don’t want is a clinical talking shop with no decision-making. What you’ve also got to be careful of, the consortia can only be accountable to the commissioning board, they can’t then be accountable to the senate and to everybody else. We want to make sure we don’t risk the senate just being set up as another layer of bureaucracy.’
‘If we’re not careful, and we have large clinical senates and we have boards with lay people and everybody else and sundry, all we’ll be doing is re-creating PCTs and reinvented the bureaucracy. How much is that going to cost and who is going to pay for it?’ he added.
Although Dr Watson did say that larger clinical senate groups could be useful for commissioning groups.
He said: ‘Clinical senates could potentially cover a number of consortia. There are some areas where they’ve got a clinical senate within a large consortia, which would be acceptable. There are other areas where you might wish to get a number of clinicians together across a number of consortia and use that as a clinical advisory body. So there’s still enough flexibility within to make something workable.’
Peter Weaving, a GP in Cumbria and joint chair of NHS Cumbria’s clinical senate, disagreed: ‘I think there will be no “one size fits all” model. It will be very difficult to legislate. You need to have clinical input from all sides, but if you start to define that you must have two consultants, a pharmacist, you’re straight back to the nonsense that PECs became. What you need to have is realistic engagement of people that matter.’
Dr Nigel Watson Health bill