Commissioning chief predicts end of traditional doctors’ contracts

BMJ 2008; 337 doi: (Published 18 July 2008) Cite this as: BMJ 2008;337:a881
  1. Rob Finch
  1. 1London

    Implementing commissioning policies to their fullest extent could introduce an era of integrated care organisations in England, spelling the end of traditional GP and consultant contracts, a debate heard this week.

    Speakers at the debate, organised by the think tank Civitas, also warned consultants of a looming threat to their future employment because NHS foundation trusts will be looking to cut “unprofitable” services.

    The debate—called “Commission impossible: is ‘world class’ commissioning achievable in the NHS?”—focused on the world class commissioning strategy published by the Department of Health last year, which set out the minimum standards that primary care trusts must fulfil to retain their commissioning powers.

    Tim Richardson, a Surrey GP and director of Epsomedical Ltd, outlined how the primary care strategy of the Darzi review allowed the creation of integrated care organisations to commission and provide services.

    He said: “The part of that strategy I really welcome is the opportunity to become the provider of our patient services along with our other colleagues in primary, secondary, and tertiary care within a single responsible provider contract—an integrated care contract.”

    “By taking it [providing services] on as a contract rather than as a practice based commissioning budget gives us that certainty that allows us to invest.”

    Mike Farrar, chief executive of NHS North West agreed, saying that integrated care organisations were “a permissive concept.”

    “It seems to me that the integrated care organisations mean that we can look at whether we want primary care colleagues to go up the care pathway or secondary care colleagues to go down the care pathway,” he said.

    But Jonathan Fielden, chairman of the BMA’s consultants’ committee, raised concerns about the bias against consultants in the commissioning process. He said: “The concern from secondary care is that to get commissioning right you have to have involvement from secondary care, otherwise you don’t properly understand secondary care.”

    “Integrated care organisations help, but if I went to my local GPs to say I can provide anaesthetic services, my trust wouldn’t let me—unless I fight a court case or leave my job.”

    Mark Britnell, director general of commissioning at the Department of Health, replied, suggesting: “The logical conclusion of the success of integrated care organisations is that they will lead to the abolition of the contracts that you’ve striven so hard to maintain.”

    Michael Dixon, chairman of the NHS Alliance and a GP in Devon, then went on to say that as a result of the improving commissioning process, chief executives of NHS foundation trusts were now undoubtedly looking to make cost savings on areas of work that were unprofitable.

    “As foundation trusts concentrate on margins and profitability, consultants will be at risk as that profitability will be key to trusts’ future,” he said.

    Keith Brent, a consultant paediatrician and deputy chairman of the BMA’s consultants’ committee, said he was “bothered” by the idea of profitability of acute services, saying that it made him “gag.”


    Cite this as: BMJ 2008;337:a881

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