“Fear is the path to the Dark Side.” (Yoda, Star Wars – Episode I, 1999)
“Commissioning in the NHS is the process of ensuring that the health and care services provided effectively meet the needs of the population. It is a complex process with responsibilities ranging from assessing population needs, prioritising health outcomes, procuring products and services, and managing service providers.” (Department of Health website, archived content, 2010)
Relating to Commissioning a transition took place over the last 14 years and it led straight into the so-called “practice-based commissioning”. It was a functional interaction between Primary Care Trusts and GPs. In 2010 the health White Paper “Equity and excellence: Liberating the NHS” (became the “Health and Social Care Bill 2011” earlier this year) was unveiled and that changed almost everything. If passed, PCTs are history and general practitioners (GPs) take over control of commissioning and budgets. Put simply, apart from their job as health care professionals they become managers too. The word is that, in doing so, they “go to the dark side”, juggling with figures instead of scalpels and stethoscopes. (The GPs on the ‘dark side’, Brennan S., guardian.co.uk, 2011)
Anyhow, this is not the time to become one-sided in the line of argument. Actually, GP fundholders (general practitioner-led commissioning system in the 1990s) have shown evidence of their capabilities in commissioning. They were able to reduce expenditures like prescribing costs and brought down hospital referrals. Moreover they proved to be more sceptical about the service offered by the various providers, which could push innovation and improvements in hospital services. They were in the thick of the action and therefore well briefed. Then again they had higher transaction costs than administrative commissioners.
Commissioning is not the only area in the NHS that faces huge changes. The whole NHS bureaucracy will be reconstructed. Will GPs come to stay in their new role? Will the system be economised without causing any damage? Questions upon questions. There´s more to come.
What is the Status Quo?
To be continued.