GPs fear that secondary care specialists will dominate the decision-making process if they are involved in clinical commissioning, claims a new report.
Primary care doctors also question whether the bureaucracy and costs involved in securing specialists for clinical commissioning group (CCG) governing bodies would produce any significant benefit.
The report, by a group called the Specialists in Commissioning Network, part of the NHS Alliance, argues that current policy on involving specialists in the NHS reforms and clinical commissioning is ill thought out.
It says Department of Health proposals for involving specialists in CCGs, clinical senates and in helping to develop and support clinical networks risks creating mistrust and professional barriers between primary and secondary care.
Some GP leaders, for example, have expressed concerns that if specialists are recruited on to the proposed new clinical senates they would interfere with effective clinical commissioning. The Health Bill proposes that 15 senates should be created to enable doctors and other professionals to come together to give expert advice on how to ensure that patient care is improved in an integrated way.
The report’s author, Dr Irani Minoo, a consultant paediatrician at Berkshire Healthcare Foundation Trust and a member of the Paediatricians in Medical Management Committee of the Royal College of Paediatrics and Child Health, says another problem is the lack of clarity about how much specialists on CCG governing bodies would be paid.
Either way this is likely to be complicated - if hospital trusts are to be remunerated for all the time required by their specialist doctors to be involved in CCGs the costs for CCGs may be prohibitively high.
On the other hand if all members of CCG governing bodies (including GPs, nurses, specialist doctors and lay members) are paid at the same level then hospital trusts may not actively encourage their most senior, experienced and expensive specialists to apply for these positions.
Irani says that specialists have said little about the policy to involve them in commissioning. Early indications are that specialists remain unconvinced that their time would be best spent sitting on CCG boards unless a specific function was identified for them.
Practising specialists would be required to serve on CCGs well outside the geographical area where they work and the time commitment involved in traveling to these meetings could be another barrier. Some specialists feel their knowledge and skills would be better utilised by CCGs in discussions about commissioning for high quality local services rather than in trying to influence governance of CCGs outside their localities.
However there are consultants and other senior career grade specialist doctors who feel they should be involved in CCGs because only they are the only doctors qualified to effectively challenge poorly evidenced decisions about commissioning specialist services.
Also secondary care doctors providing highly specialist services at regional level (spanning several CCGs) are concerned that CCGs may not understand the complexity or need for some of these specialist services to be provided at population levels beyond individual CCG boundaries.
Irani concludes: “The potential contribution of specialist doctors to the NHS reforms and especially clinical commissioning appears to have been explored by policy makers somewhat as an afterthought.
“Specialists have an important role to play in supporting clinical commissioning. Simply making proposals for specialist involvement in CCGs, senates and networks, but not providing clarification or policy guidance, can create misunderstanding between GPs and specialists and risks creating barriers to collaboration on a range of issues which are crucial for the future of the NHS.”
The BMA, Hospital Consultants and Specialists Association (HCSA) and the Royal College of Physicians, have all called for specialists to be given a role in commissioning at both national and local levels.
HCSA chief executive, Stephen Campion, said a lot of consultants would be interested in doing this type of work, especially the younger ones who would welcome the chance to take on a new role that was stimulating and broadened their expertise.
However, the reality was that many consultants were prevented from doing extra work like this. The HCSA has heard examples of consultants being prevented from working for their royal college or for the Department of Health because their employing trusts were not prepared to give them time off as they did not see it as part of their role to pay for it.
“What you would expect to happen is that consultants who have reached a specialist level should be in a position to share their expertise with the wider NHS community as well as the employer that employs them. The NHS needs to understand that there is wider expertise that the consultant can bring to the NHS other than the mechanics of being a doctor,” said Campion.
Read the full report.
Tags: Clinical senates, Commissioning
