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Primary care trusts still fail to give GPs the information and support they need to be effective practice based commissioners, according to a health policy analyst.
“If practice based commissioning exists,” Richard Lewis, director of Ernst and Young, told a conference in London, “it has been in spite of this lack of support and not because of it.”
A recent poll of practice managers and GPs by the King's Fund and NHS Alliance showed that most rated the support they received from their primary care trusts as inadequate. Almost two thirds said that they were either not receiving financial information or were getting information that was of little use (see BMJ 2007;334:1079 doi: 10.1136/bmj.39220.489306.DB).
Despite this almost three quarters were still committed to practice based commissioning, and more than half felt it would help improve care “to some or a great extent” in the coming year.
But Mr Lewis warned that this could be the government's last chance to engage clinicians after the failures of fund holding and primary care groups. “They have been brought back to the table for the third time, but it will be a long time before they go back again if it doesn't work this time.”
Meanwhile Richard Smith, executive director of United Health Europe, warned delegates that without private companies' help the NHS could founder. United Health Europe is one of 14 private companies chosen by the government to support primary care trusts with NHS commissioning.
The imbalance between the commissioning and provider sides could be disastrous and there is an urgent need to strengthen the commissioning side “to keep the NHS afloat,” he said.
He argued that commissioning health care was hugely complex and that the NHS simply did not have the home grown expertise required.
He said that this meant that the service had to buy commissioning capacity from the independent sector. The Department of Health's new framework contract, which makes it easier for primary care trusts to buy commissioning expertise from private companies, recognised this, he told delegates.
The private sector could bring new competencies to the problems the NHS was facing, said Dr Smith. It could also take on all or part of the financial risk of a new undertaking and “unlike many other players in the NHS, if we're going to have a role, we have to deliver value—or we'll be gone.”
But the best way forward is through partnership, he said: “Public and private together can do things that either on their own can't do.”
He also raised doubts whether the NHS was the best organisation to commission public health. “Doctors are much more interested in disease than prevention—all their conversations are about illness not health.” It might be better, he suggested, to rename it the National Sickness Service and “have another enterprise with a different culture that will really take the issue of health seriously.”