The BMA has expressed “fundamental concerns” over the recent white paper Equity and Excellence: Liberating the NHS, warning that it would encourage further competition in the NHS.
While it said it was not against the whole vision, extending commissioners’ choice to “any willing provider” and giving the foundation trust regulator Monitor a duty to promote competition risks shifting the focus onto cost rather than quality and compromising collaboration across primary and secondary care.
The BMA is, however, supportive of the government’s wish to devolve more control to patients and frontline clinicians, and put a stronger focus on public health.
The union is also interested in exploring proposals for most services to be commissioned by consortia led by GPs. It believes that successful commissioning can only be achieved if other clinicians, such as hospital consultants, are also brought into the process, and if there is meaningful engagement with the public and patients. It also says consortia must have sufficient management and administrative support to take on the additional responsibilities.
Consultants say they must be given a key role in commissioning services and, in some areas, take the lead in their response to the white paper on health.
Keith Brent, deputy chairman of the BMA’s consultants committee, said: “We also see the role of secondary care as crucial and want to see it firmed up – whatever model is in place.”
He said successful commissioning could only be achieved through collaboration. “The expertise of consultants can bring clear benefits to commissioners, providers and ultimately patients. There are also some pathways where we would think consultants should probably take the lead,” he said.
Brent, a consultant paediatrician, said in his field for example, consultants should take the lead in designing specialist services such as those for children with multiple disabilities and learning difficulties. Paediatricians would be also best suited to lead on safeguarding, child protection and protection of vulnerable adults.
Consultants and academics were well placed to advise on the evidence needed for effective commissioning. An example of this was in the South Central SHA region where consultants have developed a blood and bone marrow transplant commissioning policy which sets out the conditions for when it’s an effective treatment or not.
“We can be a valuable source of advice in informing commissioning decisions, advising on new technologies and service development as well as safety requirements,” said Brent. Consultants could also feed in the views of patients, particularly those with rare conditions whose needs were sometimes overlooked.
But he said they were concerned that the white paper did not make it clear where they would find the time to feed in to the commissioning at a time when many trust managers were pressurising consultants to reduce their SPAs.
He added that consultants were not under the illusion that everything in the white paper was positive. He described it as “aspirational, vague, muddled in places and contradictory in others”.
They were concerned about a suggestion that trusts could move away from national terms and conditions for appointing consultants and the emphasis on competition. Disquiet has been expressed in BMA Council and other BMA committees that the White Paper signals a move towards mass privatisation of commissioning.
Brent said: “Our stance at the moment is that there are many aspects of the white paper that are promising and that we can constructively engage with. However there are other aspects that we would question and are uncertain about.”
The consultation on the white paper closes on 11 October. Email your views to email@example.com. The first shadow GP commissioning consortia are expected to be up and running by April next year.
Read a blog on the issue.