Thursday, 24 January 2013

Who should decide what healthcare we get

On April 1st,  traditionally known as April Fools Day, the UK government is implementing a major change in the way that decisions are made about what healthcare is bought and provided for us.

They have decided that some local GPs should form groups to commission some of our healthcare.For more information on these groups, called Clinical Commissioning Groups, see my blog here.

But are GPs the right people for the job? Whether they want to do the job is another question of course? Many of them are against the idea.

The reality is that they will only be taking the big strategic decisions about commissioning and giving clinical advice on what works and what does not.  The real day to day work of managing the contracts and making sure that the providers, hospitals that is, do deliver the right services, at the right time, in the right place at the agreed quality will be done by another shadowy organisation, the Clinical Support Organisations.

Should we be giving this responsibility to the GPs? They will be doing the job part time, under resourced and with little training. Most of them would rather be seeing their patients back in the surgery.  Who will be seeing those patients while they are at meetings?

So who else could do this important job?

Social care is commissioned by managers in councils under the strategic guidance from our elected councillors.  Perhaps, as suggested by the Labour Party, healthcare could be commissioned in the same way.   The newly created Health and Wellbeing Boards, due to start work on April Fools Day, will have some say in the way our healthcare is provided anyway. The trouble is are councillors and their managers any good any good at commissioning social care? Do they have the resources and the skills to do healthcare as well as social care?

In the old days the NHS was run at a local, county level by Area Health Authorities, with GPs, consultants, managers and councillors on the board.

Then there was fundholding when a limited budget was given to each GP practice to use to buy outpatients appointments and planned operations.

Then Primary Care Trusts took over the job with a few carefully selected GPs to advise managers on what to buy.

Now its back to the GPs alone.

All very confusing and uncertain.

I have no ideas who should do this vitally important job for us. Will local councillors on the Health and Wellbeing Boards be better than the PCTs and the yet to be tested CCGs?

Finally where do we, as members of the public and all of us potential service users, get a voice in the decision making process?

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