GPs’ enthusiasm for commissioning is “evaporating,” claim peers

BMJ 2011; 343 doi: (Published 19 September 2011) Cite this as: BMJ 2011;343:d5943
  1. Adrian O’Dowd
  1. 1London

The enthusiasm of family doctors for taking a leading role in commissioning health services under the proposed NHS reforms is evaporating, claim peers.

In addition, the government’s listening exercise earlier this year to reconsider its proposed reforms has only helped to confuse the public over who is really in charge of and accountable for commissioning NHS services in the future, the peers heard during a debate in the House of Lords on 15 September.

The debate concerned the recommendations of the NHS Future Forum, the panel of experts appointed by the government to lead the listening exercise, which reported back in June on how the Health and Social Care Bill should be revised (BMJ 2011;342:d3777, doi:10.1136/bmj.d3777).

During the debate Norman Warner, a Labour peer and a former health minister, said, “The disgruntlement of the BMA and other public sector unions seems little abated. The NHS Confederation hardly seems to be bowled over.”

Lord Warner added: “The original enthusiasm for GPs running more of the commissioning show seems to be evaporating as the hospital specialists fight back to retrieve more ground through modification of the consortium [clinical commissioning group] membership.”

With various bodies now involved in commissioning decisions—such as the NHS Commissioning Board, clinical commissioning groups, clinical networks, new clinical senates (which bring clinical leaders together across broad areas of the country), and health and wellbeing boards—Lord Warner said that “the forum seems to have helped the government further along a path of public confusion over who is really in charge of NHS commissioning and accountable when things go wrong.

“In my view, the forum’s proposals make an already unsatisfactory situation worse, in terms of accountability, service needs assessment, and commissioning of services.”

Another Labour peer, Margaret Wheeler, acknowledged that the government had acted positively on some of the forum’s recommendations, such as bringing wider input into clinically led commissioning and clarity on some accountability issues.

However, she said, “Three months on from the Future Forum report, fundamental questions remain. We are still no clearer about why this massive upheaval is needed.”

Baroness Wheeler said that health professionals remained deeply concerned about the bill’s proposals and about its growing complexity.

“It is unclear how the original commitment from the government to streamline the NHS and remove bureaucracy will be met by current changes,” she said.

“How does a bill which adds more layers and bodies—increasing the number of statutory bodies from 163 to 521—[which] substantially increases costs, and [which] fails to provide a clear rationale as to why it is at all necessary succeed in improving quality of care and promoting integration?”

Bernard Ribera, a Conservative peer and former president of the Royal College of Surgeons, argued that the passage of the bill had already been delayed too much, saying that further “delay is not an option.”

The health minister Frederick Howe, answering earlier questions about the need to reform the NHS, said, “The bill seeks to create a stronger, more responsive, and more innovative NHS—an NHS led by clinicians, with patients in control of their own care and with a resolute and unflinching focus on results.”

Earl Howe argued that although the government was committed to “harnessing the benefits that competition and choice brought for patient care,” this competition would be about serving the interests not of corporations but of patients.

“It is not true that we are creating additional bureaucracy,” he added. “The changes we made to the bill as a result of the listening exercise do not create any extra statutory organisations.”


Cite this as: BMJ 2011;343:d5943