Health Matters | Paul Corrigan's blog

One of the many choices that Andrew Lansley had to make when he became Secretary of State in 2010 was whether to develop the GP led commissioning of NHS services that he wanted within the current PCT structure or whether to introduce legislation to develop that policy. Famously he decided that he needed the biggest NHS Bill in history to enact his vision. In making this choice he obviously felt that developing existing legislation would not give GPs sufficient power. To really empower GPs as the leaders of the new commissioning framework he felt he needed completely new structures and legislation.

It was therefore not at all surprising that in the White Paper, Liberating the NHS, the Government made clear their view that GPs would be running this system,

“4.3 Primary care professionals coordinate all the services that patients receive, helping them to navigate the system and ensure they get the best care (of course they do not deliver all the care themselves). For this reason they re best placed to coordinate the commissioning of care for their patients while involving all other clinical professionals who are also part of any pathway of care Page 27 “

Now, as the new system is being implemented, we can begin to see how all of this is panning out.

One of the key roles in running any system which spends public money is that of accountable officer. This accountability for public money runs from the Treasury through the Department of Health and rests in an individual who exists in every part of a public system that spends public money. They are the accountable officer.

On one occasion, eighteen or so months ago, when I was discussing the reform programme with clinicians I was asked what was special about being an accountable officer. I replied that the “accountable officer could go to prison for fraud” which whilst being a bit stark did make the point that this is a job where accountability is taken seriously.

 So one of the ways of determining whether the Secretary of State has succeeded in placing GPs in charge of the commissioning process is to see how many of the CCGs have accountable officers who are GPs.

This summer has seen the start of the process of developing a new cadre of accountable officers. People have been put through tests for verbal and numerical reasoning at assessment centres to see if they have the skills and capacities to fulfil this role.

We won’t be clear about exactly who has secured all these important posts until the authorisation process has finished, but given this summer’s selection we are beginning to get a view.

Which is that about one third of all CCG accountable officers will be GPs and two thirds won’t.

Now who knows now what the Secretary of State really thinks about any of this, but it does seem a very long and difficult process of change through which to put the NHS to emerge with only a third of commissioning actually being GP led.

GPs will be in all sorts of other positions, but for two thirds of CCGs they will not be the person who is legally accountable for the spending of NHS money.

As a process which is meant to be about empowering GPs this leaves a lot to be desired.

I end this post with an advert. Like many of my readers I lead a sheltered life – where issues of NHS reform loom larger than they do amongst the general population. I want therefore to alert those of us that ‘need to get out more’ to something that will be a real treat. This is an analysis by Nick Timmins, the ex-Financial Times public policy editor, of the battles around the Health and Social Care Bill. Called ‘Never Again’ it will be published by the Institute for Government and the Kings Fund on Thursday July 12.

I have been reading an embargoed copy and it’s really gripping. Written as a play with Acts and Scenes it’s based on a mass of research and is above all written by a great journalist who, unlike the Secretary of State really can communicate.