One of the really interesting tussles taking place over the next few months concerns who is actually implementing the Bill. This may sound like an odd issue to bring up because one might think that the constitutional process is obvious. The Government manages to get a Bill passed by Parliament, the Queen signs it, and the Government implements it.
But as the Bill becomes an Act the people that will carry out its implementation will be very different.
One of the things we learned last week was that both political parties in Government – who have been voting for this Bill at regular intervals for the last 15 months – are simply delighted that it has at last left Parliament. For them, the actors and actresses in the theatre of parliament, the show is over.
The Cabinet banged the table with glee that it had gone (Did they ever do that at your school? – No they never did in mine either.). There is huge relief in Parliament. The Bill has passed and outside the Select Committee no-one will give much thought to what happens next.
It isn’t this part of Government that does the implementing.
Insofar as politicians continue to be involved it is the job of Ministers to oversee implementation.
Now, I am now going to say something that may startle you. I know it may not have looked like it for the last 18 months, but this group of Ministers have had previous experience with Parliamentary legislation. Admittedly it was in opposition, but before this Bill they did know how to argue amendment and move legislation through.
(I know, I know, but I am not saying that this group of Ministers had learnt to do it well - just that they had some experience of doing it).
None of these Ministers have any experience of implementing a Bill in Government.
But the people who run the National Commissioning Board have been implementing legislation since before the Cabinet learnt to bang their desks when given a half day off at school.
So if you had to put money on who will be most effective in implementing this Bill I would not put much on the Ministers.
This partly explains the numbers in yesterday’s post. The accountable officers in 6 out of 10 PCTs are similar to the accountable officers that existed under the PCT system. The old system will reproduce itself in the new where it can. But the old system will where it can use implementation to grab more power than it had before.
So if Ministers are not really capable of implementing the Act and the NCB writes its own rules for implementation, then surely the field is open to just one sort of implementers? The National Commissioning Board.
But on the ground there is in fact another group of implementers – the GPs in Clinical Commissioning Groups. If they don’t implement this Act then not a lot that is new will happen. (If GPs – as accountable officers – decide to walk away, not a lot that is new will be implemented).
And within a few hours of the Bill’s passage the combination of the National Association of Primary Care and the NHS Alliance sent out the following letter to their members who are and will be some of the main implementers of the Act.
“The passage of the Bill has been nothing if not controversial. The NHS Clinical Commissioning Coalition of NAPC and NHS Alliance has been a strong advocate of Clinical Commissioners throughout, while working hard “behind the scenes” to ensure that we are given the necessary powers to match our new responsibilities. As clinicians, we now have a real opportunity to
transform local services and health.
The last few months have seen a sometimes polarised debate of strong political and professional opinions, which have led to passionate and public disagreement. In retrospect, we can all think of ways in which engagement could have been improved. We have also learnt some important lessons
around managing our relationships at a time of significant turmoil.
But now the parliamentary stage is over, it is vital for our patients and our populations that the profession and primary care reunites and finds ways of making the new NHS structures and arrangements work. As the NHS Clinical Commissioning Coalition, both NHS Alliance and NAPC are committed to helping you meet the challenges ahead. We must demonstrate quickly to our
patients, colleagues and the country that these changes have not been just some bureaucratic shift of organisational structure but that they will have a real and meaningful impact on the health and the health care of all NHS patients.
The NHS Clinical Commissioning Coalition is keen to support you in this process. We shall be publishing a monthly newsletter which will update you on everything that is going on and provide examples of the innovations, advances and improvements in patient care that you, as CCGs, are driving. Please let us know of any early wins as well as the challenges you face in your CCG so that
together, we can continue to win the argument for GPs being at the very heart of the reform programme.
Meanwhile, we must ensure nationally and locally that the new arrangements are allowed to work. That is why both of us are meeting regularly with the Secretary of State, ministers, Department of Health, leaders of the National Commissioning Board (NCB), Monitor and many others. We now
have an urgent mission and we are endeavouring our utmost to ensure that CCGs and their leaders are masters of their own destiny.
On April 24th we have organised a first meeting of CCG leaders following the passing of the Health and Social Bill. This represents a unique opportunity for us for us all to determine our own future April 24th will also be a crucial opportunity for us discuss progress and concerns and to put the results
of those discussions to the Secretary of State, Chairs of National Commissioning Board and Monitor as well as others. . Please also let us know of any way in which we can help you to make clinical commissioning a success in your area.”
It’s important not to underestimate the potential of this letter. These two GPs organisations plan to short-circuit the relationship between what is talked about nationally as policy and what happens to GPs in practice.
They plan to use the April 24 meeting to bring the experience of the actual implementation on the ground to the Secretary of State and present him with different implementation solutions at both a policy and a practice level.
This means that one of the answers to the question “who is going to implement the Act?” could be the people who are going to carry it out.
The next few months will show whether GPs will be the implementers of the Act or will have it implemented upon them.
It is actually quite feasible to underestimate the potential of this letter. It represents the views of a fringe group of GPs (NHS Alliance and NAPC) who have consistently supported the Bill. They represent themselves and a tiny group of entrepreneurial GPs who may see a financial advantage for themselves and possibly some of their patients.
Average GPs (like me) are entirely unengaged with this process. I suggest your next reading material should be the early draft risk register which appears to be an accurate roadmap of exactly the car crash that will happen.
The NAPC and NHS Alliance are trying to elbow themselves into positions of influence. They do not represent me or my colleagues.
Unless I have read this wrongly.
The clinical commissioning coalition seem to be saying ‘OK, the vast majority of you have been against these reforms but the government has bullied them through Parliament and you’re stuck with them so you might as well give up all resistance and make them work’. Well, they might work a little bit if everyone worked very hard and had 100% belief in them and was really enthusiastic. But most clinicians are not so inclined. So we have the horse and the water and the government has led one to the other. What hapens next?