Gary Jones is a member of the Bow Group Health Policy Committee and a public affairs consultant. Stuart Carroll is a senior health economist and chairman of the Bow Group Health Committee. Here they summarise the research paper they have written for the Bow Group on the Government's recent NHS White Paper, which is published today and can be downloaded here.
The Coalition Government’s NHS White Paper represents the most radical Government Health White Paper since the creation of the NHS in 1948. Whilst the White Paper signals relatively few changes in the patient facing end of the health service, the proposals to introduce GP consortia to carry out the bulk of NHS commissioning constitutes a radical and bold step.
These courageous plans have great potential to bring primary care closer to patients with a stronger focus on prevention. However, the smooth and effective implementation of this policy will be necessarily dependent on the removal of a number of practical barriers and strong leadership across the 1.3m people making up the world’s fourth largest organisation.
The Bow Group has today published new analysis on the White Paper, which outlines our considered response to Equity and Excellence: Liberating the NHS – the Health White Paper setting out the Government's long-term vision for the future of the NHS in England.
The analysis focuses on five key areas, which feature prominently in the White Paper. These include 1) GP commissioning, 2) Quality and outcomes, 3) Public health and prevention, 4) Efficiency savings and Quangos, and 5) Value and innovation. Here we summaries the main points from our analysis.
1. The GP Commissioning Revolution
The most significant and ambitious proposals set out in the White Paper are plans that will see the creation of GP consortia to take on the role of GP commissioning. Consortia will take over commissioning for the majority of NHS services. It should be recognised that the “commissioning revolution” offers great potential to drive up clinical standards and improve productivity across the NHS. It is widely considered that PCT commissioning has been a disappointment in recent years and has failed to deliver its potential. In April 2010, the cross party Health Committee published its report on commissioning concluding that PCTs are not commissioning effectively enough and that they often lack the “clinical knowledge” to challenge hospitals over the provision of services.
It is clear that enhanced GP commissioning represents an opportunity for positive change. However, this radical reform confers a number of practical barriers, which the Government will need to be overcome. This is not least the case when demonstrating to the public, and the healthcare system as a whole, that the devolution of around £80 billon of NHS resource is a wise move with previous funds being spent efficiently and effectively. In addition, it is not clear how GPs will share the risks and rewards of their enhanced roles.
It is likely that many GPs will anticipate benefiting financially from the new model as they acquire new responsibilities. It will be essential that the Government sets out a clear framework to ensure that there are robust rules on transparency and accountability so that everyone involved – GPs, PCTs, hospitals, contracted companies – know exactly where they stand, and most importantly, remain directly accountable to patients.