or meet the new regional office of the National Commissioning Board – just like the old SHA.
The current Secretary of State for Health has called his White Paper “revolutionary”.
Because I know a thing or two about the theory and practice of revolutions, I was always careful not to call any of New Labour’s NHS reforms revolutionary. They were not revolutions they were just that – reforms.
I think the current Secretary of State really does see reforms such as GP led commissioning as “revolutionary”. But if he knew his history of revolutions he would see how even the brightest of reforms get slowed down and turned inside out when you ask the current regime to implement them.
The mistake that reformists make is to make a big revolutionary claim for what they are doing and then to ask the current regime to carry them out. What comes out is much the same as the present.
The rock group the Who put this much better than either Lenin or Mao when they wrote a great song in the early 1970s called, “Won’t Get Fooled Again” The closing lines are,
“Meet the new boss, same as the old boss”
It is this déjà vu (or perhap déjà entendu?) experience that is about to hit the nascent GP led Commissioning organisations across England.
I have been waiting to see what developmental resource the current NHS HQ will put into trying to help GPs develop commissioning consortia. And I think we now have the answer.
SHAs are being asked by NHS HQ to carry out a remarkable piece of reverse engineering. NHS HQ and the SHAs are looking at the details of the White Paper and their thinking goes something like this,
- The National Commissioning Board will have statutory duty to ‘ensure the development of GP commissioning consortia (White Paper page 32) and they will be able to “assign practices to consortia if necessary” (page 29)
- It will be for the NHS Commissioning Board to decide what, if any, presence it needs in different parts of the country.(page 33)
- Given that someone from within the current machinery has to have the responsibility for developing GP commissioning consortia, let’s assume they are part of the current SHA
- Let’s assume they will become shadow regional parts of the National Commissioning Boards in the autumn
- Each SHA currently has a Director of Commissioning, so let’s assume that they become the National Commissioning Board regional officer who is currently responsible for developing GP commissioning
- And then in the future once the legislation is passed they will be responsible for the allocation practices to commissioning consortia.
Using this line of reasoning you have 10 people in post at the moment that can go around talking to GPs in the autumn of 2010 as if in April 2012 they will be performance managing them.
You can then, in the autumn of 2010, gather round these proto-regional officers of the National Commissioning Board staff that will be carrying out these functions who will then be the staff who will carry out the day to day performance management of GP commissioning consortia. These staff will be the current staff of PCTs.
This means by the autumn of 2010 you will have empowered the same SHA and PCT staff you have at the moment. They are currently carrying out one role as NHS bosses to become a part of a new organisation carrying out a brand new role of liberating the NHS..
It’s seamless. You can’t see the join.
This is not the way to make something new happen. And this is of course what is being planned. The old tries to grab hold of the new by any means available.
I need to declare a big personal interest here. I used to be the London SHA Director of Commissioning and for 18 months used to have a monthly meeting with the other 9 SHA Directors of Commissioning.
These are good and clever people who have been at the forefront of thinking through and implementing reform. There were times in the last 3 years when they and a few staff in the DH were the people who were thinking through the next stages of the reform programme.
BUT (and this is a ‘but’ about me when I was working in the NHS as much as it is about them). Some of us – including me – had never actually commissioned a contract for health care and – more importantly for this task – virtually none of them had experience of starting and developing small businesses.
Over the last year I have been spending a lot of time with GPs discussing these issues and they do not think, talk or act like members of large state organizations. They are small business people. If you want to work with them on their development, you need to work with what and who they are and not treat them as if they are part of large scale NHS organisations.
Board Directors of SHA are about as far away from the experience of running a small business as you can get and still be living in the same country. If you give them this task they will do it with great skill – with reference to the experiences and skills that they have to hand – and not the ones that are needed.
“I am from the SHA and I am here to develop you” (and in 2 years time to performance manage you) is not going to lead to new organisational forms carrying out new tasks.
So the current Secretary of State for Health may be having his revolution snatched from under his nose.
If you want to develop GP commissioning consortia why not ask GPs and their organisations to do it?