I wonder if the British Medical Journal really thought through working with The Times on their joint investigation into CCG commissioning. The resulting front page headline ‘GPs award £2.4bn deals to their own companies’ hardly gets across the nuances of how these contracts are awarded.
It adds further fuel to the myth that GPs are purely motivated by avarice and appears to blame them for the NHS reforms that many in the profession vociferously opposed. In many ways, an own goal.
And these are not ‘groups of family doctors’ as the investigation claimed, in fact the majority of members on CCG boards are not GPs and the constitution of most CCGs means that GPs with a conflict have to step out of the room anyway when any decisions are made about a contract.
I also understand that many of these so-called ‘conflicts’ are merely penny shares in out-of-hours co-operatives and the like. Hardly the ‘free for all’ claimed by The Times.
But what is the alternative? A return to the blinkered commissioning of primary care trusts? Goodness, no.
The one solitary success of the (otherwise disastrous) Lansley reforms has been to boost clinical input into the way commissioning decisions are made. We must not forget that those with the most valuable experience to offer CCGs are likely to be those who have more entrepreneurial interests. GPs involved with provider companies will have the insider knowledge that will ensure that patients – rather than process – are at the forefront of any decisions made.
Surely the point is transparency. Perhaps there is a case for GP commissioner conflicts to be more openly declared and the rationale for CCG decisions to be shared more widely. And despite the miserable headline, perhaps the BMJ and The Times can be praised for one thing: highlighting the increasing absurdity of the internal market in the NHS.
CCG leaders across the country are planning radical changes to GP budgets under co-commissioning, including radical shifts of care into the community. This will see funding shift to GP services and perceived conflicts increase.
The advent of the new GP contract in 2017 is likely to give even more local flexibility to commissioners and the rise of massive super-practices and ‘accountable care organisations’ fusing primary and secondary care – as encouraged by NHS England under the Five Year Forward View – will make a mockery of the purchaser-provider split in the English NHS.
The presence of these ‘mega providers’ will inevitably distort commissioning decisions. It will be become nigh impossible to block accusations of conflicts of interest as most GPs in the area will have some sort of connection with these large entities.
Perhaps the most imaginative solution to this mess is the simplest. Abolish the purchaser-provider split altogether. Some claim that this artificial barrier costs around £5bn to service, valuable money at a time of deep austerity in the health service. There is little evidence that it leads to a more efficient health service and the NHS seems to work pretty well in Scotland without this strange Chinese wall built into the architecture of their health service. Perhaps it is time we took their lead in England as well.
Sweeping away competition and enabling purchasers and providers to work together in the best interests of patient care is surely the best – and perhaps, only – way forward.
Surely even The Times couldn’t have a problem with that?
Nigel Praities is editor of Pulse
