Intended for healthcare professionals

Rapid response to:

Editor's Choice

Sleepwalking into the market

BMJ 2013; 346 doi: (Published 20 March 2013) Cite this as: BMJ 2013;346:f1850

Rapid Response:

Re: Sleepwalking into the market

Dr Godlee appears to be unaware of the real, immediate problem facing Secondary Care; the lack of clarity about which commissioner (i.e. the actual person or office) with whom to negotiate specific contracts.

Some aspects of the service (for example, psychosis) have potential subcontracts with national, regional and local bodies, with major problems dividing the financial responsibilities.

My own area of interest - Dementia Care - ideally needs a combined secondary care package - between Geriatrics, Old Age psychiatry and Radiology - to be effective. I cannot see this is easy to organise despite ongoing good relationships locally between the departments (not necessarily reflected in managerial relationships).

The department of health is very likely aware of this issue, which might well end up in private health brokerage firms (like virgin health care) being handed over functions of achiving contact, and to 'knock heads together'. These firms will receive 'appropriate' reinbursement for their efforts, with the NHS footing the bill.

Perhaps what the ministers were hoping for anyway!

Competing interests: No competing interests

25 March 2013
Prasanna N. de Silva
consultant old age psychiatrist
Tees, Esk and Wear Valleys NHS Foundation Trust
Anchorage, 11, Byland Road, Whitby, YO21 1JH