GP Commissioning in the UK Health system – the BMA step into the breach

We featured the move to GP Commissioning in the UK Health Service when it was announced here and on our Supply Management blog, and some of our concerns about how it would work operationally and the risks to both taxpayers and patients.  That is not to say it is an incorrect 'policy' decision; but the devil is, as always, in the practical detail.

In the absence of any further guidance or direction (not in the public domain anyway) from within Government, the British Medical Association General Practitioner's Committee, who represent GPs, has stepped in with a very good document aimed at helping GPs preparing for their new commissioning role.

It suggests that commissioning groups with fewer than 500,000 patients may not be viable; which would suggest a final picture with perhaps 100 such groups across England rather than the 500 initially proposed (which we said would inevitably prove inefficient).  It makes some good points about separation of duties / conflicts of interests (how to handle situations where GP groups commission services which the GPs themselves may wish to deliver).  It also makes quite a strong pitch for groups to consider employing commissioning experts from the NHS (PCTs presumably).  Bad news for McKinsey's, various US health insurers, and quite a few friends of mine who have already identified the gold-mine around helping GPs run decent procurement processes! But some GPs don't have the higest regard for PCT staff, so it will be interesting to see how that pans out.

But the element from the BMA document that the Health Service Journal have picked up on is this.

"Faced with the need to slow growth in spending, the health secretary has rightly suggested that more effective commissioning is the best way to drive efficiencies. He has also suggested that GPs are best placed to spot potential savings.

The BMA begs to disagree. “There should be no expectation that an effective commissioning process will generate freed-up resources on a regular basis,” it says.

Let us hope this is simply a negotiating position, otherwise the NHS is heading for a very painful reckoning."

Will moving to GP commissioning save money? Improve patient care and outcomes?  Make GPs wealthier? Take the UK towards a US style health insurance system, or perhaps a Dutch approach? These are the huge uncertainties, and explain why there is perhaps growing concern about the move; the Unison union application for a judicial review will be interesting.

We don't do 'politics' here; but this is the UK 'procurement' issue that may well have the greatest impact on the lives of most British people over the next few years.  So we will continue to watch with interest, and comment within the bounds of our experience and knowledge!

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