By Gareth Iacobucci
The new NHS Commissioning Board should delegate responsibility for managing GP contracts to GP consortia 'wherever possible' to allow greater levers for managing primary care performance, says the NHS Confederation.
The NHS Confederation has also rejected calls for it to become mandatory for consortia to appoint specialists onto their emerging boards, and said that even if they choose to, doctors should be selected from different geographical areas so as to avoid conflicts of interest.
The recommendations are contained in the NHS Confederation's submission to the Government's listening exercise on the health bill, which calls for a 'significant overhaul' of the reforms to place greater focus on the financial challenge gripping the NHS, and the need for greater integration of services.
The NHS Confederation said it backed the broad principles behind the reforms, including the introduction of clinical commissioning, an enhanced role for local government in improving health and well being, and a greater focus on outcomes.
But it said the changes as they stand are not 'sufficiently focused' on the problems facing the NHS, such as the financial squeeze, too much variability in the standards of care, and the need to better integrate services for patients.
'Wherever possible, the NHS Commissioning Board should delegate responsibility for managing GP contracts to consortia so they have all the levers for managing general practice performance at a local level.'
'Clinical engagement should not be confused with consortia governance, so there should not be a requirement to include a specialist clinician on the board. If the Government is minded to make this a requirement, specialists should not be from the local area – to avoid concerns about conflicts of interest – and should be required to have a broad overview of clinical services not just their own specialism,' says the submission.
Mike Farrar, the NHS Confederation's new chief executive, said: 'We are absolutely in favour of reform because it is crystal clear that we cannot go on as we are. But we are determined to do more to ensure the NHS concentrates its fire power on the issues that will make a difference to patients – getting better value for the taxpayer, treating people with dignity and closing the gaps between services.'The Confederation says the reforms require 'significant overhaul' The Right Reform for Patients Other key recommendations
- Consortia and the NHS Commissioning Board should comply with the Nolan principles of public life and have boards with independent members who meet in public and publish their papers.
- Consortia should be held to account by the National Commissioning Board for the outcomes they achieve but also through Health and Wellbeing Boards to ensure the priorities and plans they set reflect the needs of local people.
Competition and economic regulation
- Competition should be used where it can be shown that it delivers benefits to patients and the taxpayer. Local commissioners should apply principles at a local level to determine when and how to use competition.
- Competition and integration do not need to be contradictory. Monitor's main duty should be to protect and promote the interests of people who use healthcare services and taxpayers, and it should have a duty to promote co-operation and integration alongside competition.
Education and training
- ‘Major change required to address ‘significant mismatch between what patients need now and what is actually being provided'.
- An urgent need for a ‘Plan B' before SHAs are abolished. One of a number of options is to place responsibility for education and training in large hospitals, though this must not become a permanent solution by default.
- A flexible timetable for the transition to new commissioning consortia will help minimise risks. This could involve consortia taking a staggered approach to taking on full responsibilities, while alternative NHS bodies oversee commissioning in places where consortia have not yet been established.