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GP Commissioning: dispatches from the frontline

Dr James Kingsland, Merseyside GP and national lead for clinical commissioning, introduces his new column - exclusive to Pulse - where he will chronicle his commissioning experiences from around the country, and provide dispatches from the practice coalface. 

I'm delighted to be starting a regular column in Pulse. This will provide both a monthly review of clinical commissioning development nationally as well as an interval personal view of local CCG progress from my own practice's perspective.

In this column I hope to give some clarity to the current NHS reform agenda, dispel myths and misinterpretations and stimulate some momentum behind what needs to happen, as there really is no plan B.

As I travel the country many colleagues voice their concerns about the reforms and the need for legislation. They tell me that developing a patient centric service with clinicians controlling the NHS budget in order to produce better outcomes is desirable. Similarly the need to reduce bureaucracy and waste in the system is vital – but they do not support the reforms!

Lest we forget, the main objectives of the Bill are;

- To create an NHS led by clinical decision makers that is more responsive to patients and fosters continuous quality improvements.

- Shape an NHS which drives up standards of care, eliminates waste and achieves outcomes that are among the best in the world.

- Ensure patients genuinely share in making decisions about their care and have more choice and control.

Legislation is primarily required to align clinical and financial accountability and put clinicians and their patients in control of NHS resource deployment.

The currency of any CCG is the practice and list based practice remains the cornerstone of the NHS. Commissioning reform is about each and everyone in clinical practice being involved. Patients define quality at the interface with their consulting clinician and this is where we will get ‘commissioning at scale' improvements.

This is possibly our last chance to rejuvenate this, our most cherished public service, with a real opportunity to reform care rather than what many of the previous attempts at reform ended up doing – merely restructuring the service.

No-one said it would be easy, but if managing the service is more complex than delivering the care then a major malfunction has developed within the NHS.

Dr James Kingsland is senior partner at the St Hilary Brow Group Practice, Wallasey, Merseyside, National Clinical Lead, NHS Clinical Commissioning Community, and president of the NAPC