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Passed or not, this bill has set a new agenda for clinical commissioning

The bill looks as if it's going to make it. The coalition Government might well pay a political price at the next election but at this late stage, and given the amount of face that would be lost if they dropped it, I see no Government u-turn.

Many have asked why there is the need to have a bill when theoretically PBC could have put GPs in the driving seat without any legislation.

The problem with PBC was the culture. PCTs would give so much power to GPs and then panic and rein it back in.

Commissioning groups tinkered at the edges... the odd dermatology redesign, a fluffy teenage sexual health clinic or some other one stop shop. With the advent of the bill and the need to ensure they don't inherit a deficit CCGs have gone straight to the big commissioning issues – urgent care and referrals.
And even in these early days they are already taking on the acute trusts.

In Worcestershire three CCGs are withholding £1.2 million and in Northamptonshire two CCGs are withholding £56,000 in payments from their acute trusts for failing to meet A and E waiting time targets.

GPs would never have truly been in the driving seat without the gravitas of a bill to show the Government was serious about clinical commissioning.

But while the bill has taken power away from PCTs it doesn't necessarily mean it has transferred automatically to CCGs.

And this is where the bill has let itself down.

The implementation and commissioning support arrangements have proved as clear as mud.

‘I thought I was having a bad day' was how one senior academic described their reading of the DH's ‘co-produced' document on the commissioning support arrangements.

Results released today from a clinical commissioning coalition survey show that in most cases CCGs have been ill-informed about the choices available to them while a worrying 20% said they had decided to continue to use their PCT as they were too busy to explore other options.

Hackney CCG, one of two CCGs to publicly call for the bill to be dropped in the last week, has done so not because of fears of NHS privatisation but because of its frustration with the authorisation process as it watches PCT colleagues having to set themselves up as a commissioning support organisation rather than being able to get on with their day jobs.

The main public accusation of the bill has been opening the door to privatisation. What I sense is growing public awareness of how the private sector already has a role in the NHS given the internal market that was set up over a decade ago.

And this is where the fallout from this bill could get interesting.

We could see more commissioning enthusiasts walk away because of the poor handling of  commissioning support arrangements and clumsy clinical senates.

But more GPs on the ground could start to believe clinical commissioning is the way forward.

The RCGP and GPC oppose the bill – but they support clinical commissioning. Their next move must be to say more about what they would do differently to make the context right for clinical commissioning to happen without wasting money on a costly transformation.

Another fallout could be that more patients opt to have services from NHS providers rather than private out of a sense of NHS loyalty.

Some say Margaret Thatcher changed the Labour party more than she changed the Conservatives. The policy context of British politics changed so much it forced the modernisation of the Labour Party and New Labour was born.

This bill might just have done more to the public and GPs yet to engage with commissioning than it has done so far for the die-hard commissioning enthusiast.


Sue McNulty is editor of Practical Commissioning