Hospital specialists, and not just GPs, should be appointed to consortium boards and be a central part of all commissioning decisions to make sure patients receive integrated care.
That’s the message from the Royal College of Physicians in its response to the Future Forum, as part of the government’s listening exercise on the Health and Social Care Bill 2011.
The RCP says it strongly supports the principle of clinically-led commissioning. Secondary care specialists and other relevant healthcare professionals, such as public health specialists, should be part of planning and commissioning decisions at both national and local levels. Only they can provide specialist expertise and facilitate the delivery of integrated care for patients.
It says consortia should be renamed Community Commissioning Boards to reflect this broader involvement. GPs should reciprocally sit on the boards of Foundation Trusts.
Collaboration must be valued more highly than competition, with regulators taking an integrated approach to cooperation, competition, quality and safety.
The RCP’s mission is to set standards, measure, and improve the quality of medical care, and to promote patient-centred care. The current divide between care quality (Care Quality Commission) and economic regulation (Monitor) could lead to a bureaucratic and disconnected system in which competition becomes more important than standards of patient care. One option could be to merge the two main health regulators, Monitor and the CQC, in order to allow a more seamless and efficient regulatory process.
The NHS Commissioning Board must formally involve the royal colleges in its structures to embed standards, raise quality and promote integrated care for patients across the country.
The RCP is responsible for maintaining high standards of postgraduate education and training for hospital doctors in 30 medical specialties, running exams and education and training programmes. It is greatly concerned that the proposals set out in Developing the Healthcare Workforce do not fully recognise the complexity of medical education and training, nor the potential detrimental effects on patient care, if future structures are wrong.
The government should postpone any restructuring of education and training for two years, and meanwhile retain postgraduate deaneries to ensure that increasing service pressures do not threaten the training of the next generation of doctors.
RCP president Sir Richard Thompson said: “The RCP is pleased that the government paused the progress of the Bill to listen to patients and health professionals. We strongly support the move towards clinically-led commissioning, but to make integrated care a reality, hospital doctors must be given a place at the top table alongside GPs. Hospital doctors across the country want to work with their GP colleagues to make sure patients receive the highest quality care, and we need a Bill that promotes this.
“Quality, collaboration and integration must be at the heart of the health service and these principles - not competition - should be the focus of health service regulators. We hope to see major changes to the Bill that acknowledge and reflect these genuine and deeply felt concerns, and that the listening exercise will continue, allowing for further input from health and patient organisations.”
The BMA, in its submission, went a step further calling for the Bill to be withdrawn.
In its formal submission to the Future Forum, the BMA says the legislation represents “an enormous risk” during a time of huge financial pressure for the NHS.
It says disquiet among NHS staff is being exacerbated because change is already being implemented despite the announcement of a ‘pause’. Over 80% of just under 1,000 BMA members who completed a feedback form on the BMA website in May said their attitude to the reforms was either mostly or very unwelcoming. When asked which area of the reforms was potentially the most damaging, just over half identified the powers to be given to NHS economic regulator Monitor to promote competition.
The BMA submission to the Future Forum calls for “a more mature form of commissioning”, based on clinical networks of specialists and primary care professionals working together across traditional boundaries, alongside commissioning consortia.
It agrees with the RCP that Monitor should not promote competition, all clinical staff should be involved in commissioning, and deaneries should continue.
The BMA adds that there should not be an artificially rigid timetable for all NHS trusts to achieve foundation status, as the current deadline of April 2014 could compromise patient safety.
And the secretary of state’s duty to secure the provision of comprehensive healthcare services for the people of England should be reinstated.
The NHS Commissioning Board should be required to consult with consortia, where changes affect them, before making use of its powers to ensure an appropriate level of freedom. And patient consent should continue to be required for disclosure of confidential patient information.
Dr Hamish Meldrum, chairman of BMA council, said: “The message from doctors is clear and simple - the Bill must be changed significantly, if not withdrawn altogether, if the NHS is to continue to improve. We are right in the thick of the challenges the NHS faces, and while change is necessary, this major upheaval is not.”
Read the full submission.
