Surgeons’ advice will be essential for GP consortiums to succeed, warns royal college

BMJ 2010; 341 doi: (Published 06 October 2010) Cite this as: BMJ 2010;341:c5540
  1. Adrian O’Dowd
  1. 1London

Advice from specialists such as surgeons will be crucial for the new commissioning consortiums to succeed once the reforms of the NHS in England are fully adopted, it has been claimed.

On 4 October the Royal College of Surgeons of England published its consultation response to the government’s white paper Equity and Excellence: Liberating the NHS, which sets out reforms creating powerful commissioning groups of GPs, overseen by an NHS commissioning board.

The college said that the reforms would work only if partnerships between primary care and hospital clinicians were strong.

In its response to the white paper the college broadly welcomed much of the government’s proposals, saying, “It is essential that the proposed GP consortia and the independent NHS commissioning board have access to timely and relevant clinical information and expertise to ensure that decisions are based on the best available evidence.”

It was worried, however, that skills in some areas might be lacking. The response said, “We have concerns that the proposed plans for commissioning by GP consortia could find difficulties in accessing the skills necessary for the commissioning of some of the more specialised areas of medical, surgical and dental practice. The medical royal colleges can play a significant role here.”

Formal mechanisms should be set up to allow professional organisations and the Department of Health to gather clear and easily accessible information on outcomes, the college also said.

Under the white paper’s proposals the health secretary will hold the NHS commissioning board to account for delivering better health outcomes through a national NHS outcomes framework. On this issue the college said, “We strongly support the underlying principles of the outcomes framework and the proposals to focus on clinically credible and evidence-based outcome measures.

“In order that the aspirations of the outcomes framework are achieved consultation is vital. Professional organisations such as the college have a wealth of expertise and experience and we would like to see a formal mechanism for engagement between the Department of Health, the government and the professional organisations.”

It was vital, it said, that information on outcomes is presented in an accessible and meaningful format.

“In particular, we would wish to see the development of tools to enable doctors’ timely access to routinely collected data and the analysis thereof so that they can understand and benchmark their performance.”

The college welcomed the government’s proposals to require providers to register with the NHS regulator, the Care Quality Commission, and to be licensed by the economic regulator of NHS foundation trusts, Monitor, but added: “There needs to be greater clarity on the new roles for the regulators.

“There is confusion over which organisations will require a licence from Monitor to deliver NHS services and this requires clarification.”

The white paper also presented an opportunity to re-examine clinical research priorities, said the college, which pointed out that surgery was a key element of treatment for 30% of all patients admitted to hospital, yet in 2007 only 1.4% of a £1.5bn (€1.7bn; $2.4bn) government budget for medical research was spent on research in surgery.

The college’s president, John Black, said, “We welcome the government’s commitment to uphold the values and principles of the NHS. We commend the approach to put patients at the heart of the NHS along with a focus on clinical outcomes and leadership and a move away from targets that have no clinical relevance.”

The Royal College of General Practitioners, also publishing its formal response to the overall white paper this week, said that although its members supported the desire for stronger clinical leadership in commissioning services, some issues needed to be dealt with.

Training, time, and resources would be crucial, said the college, which gave its backing to the principle of “shared decision making” with patients and the white paper’s principle of “no decision about me without me.”

Steve Field, the college’s chairman, said that the principles of greater GP leadership and influence were well received, but members had expressed concerns that the proposed scale, pace, and cost of change would prove disruptive and were unjustifiable.

GP members were also concerned that the new structure would create problems for cross border areas, particularly between England and Wales, and that the different requirements being placed on GPs in England as a result of commissioning might result in differing training requirements and levels of skills and experience.


Cite this as: BMJ 2010;341:c5540


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