Intended for healthcare professionals

Observations Body Politic

Keep GPs in the driving seat

BMJ 2011; 342 doi: (Published 01 June 2011) Cite this as: BMJ 2011;342:d3382
  1. Nigel Hawkes, freelance journalist, London
  1. nigel.hawkes1{at}

Consultants may hate it, but commissioning consortiums need the minimum number of constraints

As it struggles to rescue its health reforms, the government is in danger of getting the worst of all worlds. By attempting to appease its critics and reconcile its internal differences, it risks retreating to a system of entrenched medical interests each doing their own thing and spending their spare time arguing over resources.

How best to get the highest quality healthcare at the lowest cost? For 20 years we have worried at this particular bone. Splitting purchasers from providers, introducing choice and competition, and elevating commissioning to a central role have been the levers of change. They have all proved weaker than their originators hoped but—if you squint—you can discern some evidence that in recent years the English NHS has performed better than those in the devolved administrations, which have followed a more collegiate organisational style.

Health secretary Andrew Lansley’s aim was to make the levers stronger by increasing competition and improving commissioning. But every step in this 20 year evolutionary process has been fraught with difficulty. He therefore needed to do it in a way that did not animate its opponents …

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