Filed Under (Clinical Commissioning Groups, GP Commissioning, GPs, Health Policy) by Paul on 29-11-2011
Back in April someone who was just about to start working for the Government on NHS reform asked me what the biggest risk was to their success. I said I thought it was clear. The biggest risk would be what would happen if the vast majority of those GPs that had once been enthusiastic about commissioning lost interest and walked away?
They couldn’t see this as a possibility. And over the last few months I have been surprised at how few people have given this any thought at all.
Since last autumn the Secretary of State has repeated over and over again that more than 90% of the country is covered by pathfinder GP consortium. He talks a great deal about the enthusiasm of GPs for taking over commissioning.
As recently as November 8th I posted about his speech to the NAPC where he thanked them for their enthusiasm. But, as I noted, at that Conference the first two questions to him, whilst thanking him for the opportunity to commission NHS care, pointed out that the DH and the nascent NCB were not allowing them any room for manoeuvre to commission locally at all.
The reality for most GPs is that the nascent CCGs are being engulfed by the much more powerful instructions that are spinning out from the DH/NCB machine. Let’s face it, the NHS centre – with its regional and sub-regional arms – have a strong track record of trying to tell local commissioners what to do. At the moment local commissioning is enfeebled.
The old PCTs have been emasculated and the new CCGs don’t actually exist.
Over the last couple of months what I have been hearing – from across the country – are stories of GPs being told to come to meetings at 8 hours notice; told to rewrite submissions over a weekend and generally kicked all round the room by sub-regional and regional parts of the NHS.
I have heard GPs asking ex PCT leaders if it has always been like this. Whilst PCT staff do not want to diminish GP enthusiasm, they also want to let them know that yes, probably, this sort of frantic authoritarianism is what has passed for a lot of DH commissioning management.
So the Secretary of State is correct in saying that there is a lot of enthusiasm and commitment. But it is washing up against a set of central instructions which make it increasingly difficult to maintain any enthusiasm at all.
The assumption being made is that the Government has GPs over a barrel in some way and that they will have no choice. If they want to engage in commissioning then they have to put up with whatever the DH puts them through. Of course that’s true – but for only as long as GPs feel they have no choice..
My point is that in fact power is moving in the other direction. What would happen if GP organisations said, “GPs are being treated so badly that they think that they will not be able to carry out the policy and responsibilities they are being offered. Unless this changes radically we won’t do it.”
Just imagine where this would leave the Government.
- They will have virtually finished a reform programme without the Bill having completed Parliament.
- They will have virtually abolished PCTs without the sanction of Parliament.
- They will have created the shell of the organisations needed for GPs to lead commissioning.
…and then GPs say that whilst they would quite like to do this, the conditions required for them to succeed are just not there. So we won’t do it.
What would the Government reform programme look like if the GPs walked away?
It’s impossible to imagine a greater disaster for the Government.
Just the thought of it places the GPs in a very strong position.
BUT – have GPs got the bottle to actually say and do this?
If they start to – at tomorrow’s NHS Alliance Conference – the Government will find that all of the problems that their reform programme has experienced up to now would become very insignificant.
They will have destroyed the old form of commissioning but will not have the staff to carry out the new one.
All it would take is for GPs to recognise the immense bargaining power they have…