Joint commissioningBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6954.608a (Published 03 September 1994) Cite this as: BMJ 1994;309:608
EDITOR, - I take exception to Christopher Heginbotham's criticism of the slow development of commissioning in Scotland and Northern Ireland.1 The fact that commissioning in Northern Ireland was not approached with the breakneck speed too often seen in England and Wales allowed us to develop a model and negotiate it with our local general practitioners, which we believe addresses most of Heginbotham's recommendations.
Under the model, five general practitioners were appointed jointly by the local medical committee and the health board to represent designated localities and help shape our purchasing plans and contracts. A general practitioner commissioner was also appointed to serve as a member of the board's commissioning forum. As it turned out, two of the five locality coordinators appointed are fundholders. Because of our responsibility in Northern Ireland for both health and social services, several of the board officers appointed to liaise with these general practitioners are social workers. The early evidence suggests that this system is able to deal with the full range of health and social service problems, from community care to acute hospital medicine. We believe that in practice the objectives set by Heginbotham are being achieved - that is, achieving a seamless service, avoiding cost shunting, and promoting innovation. I recommend that my English colleagues should take a look at Northern Ireland's models to obtain a complete picture of the possibilities and potentials for structural change.