Intended for healthcare professionals


A letter to the next secretary of state for health

BMJ 2015; 350 doi: (Published 29 April 2015) Cite this as: BMJ 2015;350:h2296

Re: A letter to the next secretary of state for health: the future of the NHS, the internal market and the role of CCGs

It is disappointing that the dual messages, "end the internal market" and "remove artificial boundaries between primary and secondary care" are not coming through stronger, either from politicians or health care leaders. They are there in Simon Stevens’ "Forward View" and it would be good if this well thought-through document was built on to present a clear direction of travel towards a workable solution for our future NHS.

Of course, we must achieve integration of social and health in community services for the frail elderly - as we have already managed for mental health services. We need also to provide a reasonable environment in which general practitioners can work and resolve the tensions between continuity and access, build physical activity and health improvement into our communities, and install patient-led management into our approach to long term health conditions.

The major drain on current NHS resources is the administrative and information overhead of the internal market. Small commissioning groups write detailed specifications and try to find mechanisms to review hospital returns and meaningful ways to monitor other providers. Hospitals ask staff to complete data on the wards in duplicate and triplicate, while still, in many places, struggling to install and make available the patient system.

The perverse incentives of profit-making GP groups offering specialist services while not reducing the burden of hospital referrals, and profit-orientated hospitals providing discharge teams to keep wards full all year round is the rot in our current configuration.

Where does this leave CCGs? Many are too small, have (in general) few seasoned and senior managers, and significant costs (in terms of administrative and resource requirements) fall on hard pressed GP practices. CCGs are beset by too many decision makers, spending expensive time kicking policy between committees, with few available to write detailed tenders or develop models for delivering change.

CCGs need to be bigger and properly resourced with full time and experienced non-clinical managers at all levels. They could then be well placed to oversee the morph of commissioners, public health, hospitals, GP surgeries, mental health teams, integrated community teams and primary care specialist services into one population-focused organisation responsible for integrated community, primary and secondary health services and health improvement.

Competing interests: No competing interests

05 May 2015
Sarah C Evans
GP Principal
Davi Denton
Totternhoe Dunstable Bedfordshire