The sands have shifted under the Health and Social Care Bill over the last 18 months. It seems a long time ago since the excitement (for some) and sense of liberation (at least for clinicians) at the publication of the white paper in July 2010 (yes, that long ago). The most vatic of statements is that with the benefit of hindsight things may have panned out differently.
The ‘pause' didn't really help. It served to confuse. The loss of narrative behind the reforms has largely been lost. The Future Forum attempted to regalvanise and solve contentious issues, but became a catalyst for ever-increasing disquiet concerning the reforms.
For clinical commissioners, possibly the biggest change in policy has been the move from affinity to geography to determine the construct and configuration of CCGs (formally GP consortia, of course).
It still remains unclear why we changed from consortia to groups (albeit a good move from GP to clinical?). However, if the policy interpretation of the bill is that a clearly defined geography must be identified by a CCG, reconfiguration for many is inevitable. Some have gone from ‘pathfinder' to unauthorisable in just a year.
We still need to move to a new paradigm within these geographies and create something remarkably different to PCTs. To do otherwise would be unthinkable.
Presently the biggest risk for the reforms and potential waste within our NHS is any further waste of time, enthusiasm or spirit - all significant factors which could stifle innovation and entrepreneurialism. We now really just need to get on with it, light the blue touch paper and deliver answers rather than ask more questions.
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
