Author: Steve Ford

Date: 26/11/2009

Organisation: HSJ

Extract:
Practice based commissioning should be replaced by consortia with “real” budgets but comprising clinicians from both primary and secondary care, according to a think tank report.

The Nuffield Trust and the NHS Alliance this week called on the government to consider “radical alternatives” to GP commissioning to engage frontline clinicians in service design.

While the Conservatives have said they will give GPs “real budgets” to incentivise commissioning, the Nuffield Trust and NHS Alliance have suggested a more major shake-up is needed.

Their joint report Beyond Practice-Based Commissioning: the local clinical partnership calls for new organisations made up of groups of clinicians based in hospitals and in the community. These would be known as local clinical partnerships and would typically be led by a GP but with the active involvement of specialists, nurses and pharmacists.

The two organisations based their conclusions on workshops with clinicians, managers, academics and other stakeholders.

The report said: “With PBC apparently unfit for purpose in its present form, and [primary care trust] commissioning frequently cautious and tentative, further thought is urgently needed as to how to boost commissioning, and specifically how to nudge or evolve clinically led commissioning into life.”

Nuffield Trust head of policy and report lead author Judith Smith said: “If clinicians are going to play a key role in designing and changing services during this uncertain period radical action will be necessary.

“PBC has shown patches of promise but we need a more far reaching alternative that re-engages GPs and other clinicians in this agenda. We believe groups of clinicians working together in local clinical partnerships could not only revitalise local commissioning but also improve the quality of care patients receive and potentially save the NHS money at this critical time.”

PCT Network director David Stout said: “We welcome the emphasis in this report on local clinical leadership and better integration across historical primary and secondary divides.”

But he added that “further discussion and testing” was needed on the significant practical and policy changes needed to implement the local clinical partnership model.

The Commons health committee is carrying out an inquiry into commissioning, including practice based commissioning, which held its first oral evidence session last month.

View article on the HSJ website

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