Two years ago, Primary Care Trusts (PCTs) - the bodies formed to monitor, commission and provide healthcare services to patients in each UK region - were split into two different enterprises. The first retained the name of “PCT”, but were given the role of monitoring and commissioning care only. The second took on the role of provision, often as private entities in competition with one another for contracts commissioned by the PCTs.
These latest reforms will see the removal of the PCTs altogether. They will be replaced by GP consortia - collections of GPs within a defined area, that will run and commission the healthcare in the consortia’s region.
There has been much debate of the relevance of using GPs to do the job of commissioning, which until now has been led by groups of professionals with a range of healthcare backgrounds. Their main role was to find the right provider for the varied health needs of a population. The GP consortia will be expected to take over this role as well as maintain and run the practices where they work.
Many managerial staff within different parts of the NHS feel that the long-term care of patients with complex health needs could be forgotten about. Communication links between healthcare staff working with such patients and GPs will need to be strengthened.“GPs have good knowledge of the things that GPs deal with, but they don’t always have a clear understanding of all of the wider health issues,” said one source who works at a service provider in London that offers healthcare services for people with learning disabilities. His concern was that certain areas, like the provision for learning disabilities, may be lost in the reshuffle.
“It really isn’t clear how commissioning will work in these more specialist areas. I suspect some will be done locally and the rest done by specialist providers.”
The break up of the PCTs two years ago has already changed the NHS dramatically. Using external providers for supplying commodities, such as beds and long-term treatment schemes, has introduced an element of competition that has not been seen in the NHS before.
“I don’t disagree with competition in the NHS – it keeps cost down and pushes quality up – but only if done properly. The health outcome is the most important thing,” explained a physiotherapist working in South London.
However, what is still unclear is how these other healthcare professionals will be considered in the latest reforms, especially those currently working as commissioners. Many will be made redundant, which is not only a waste of talent, but also a huge expense to the taxpayer in order to pay the redundancy packages.
Moreover, competition between the providers could lead to the specialisation of the services they have to offer. This may cause some providers to drop certain services altogether, and focus on where they have the most to gain financially. This is one way that provision could be improved, leaving a number of specialist providers that have high performance in the areas they are working in. However, the fear that the GP consortia will not understand all of the long term health issues covered by a certain population is one that remains in the minds of NHS managerial staff.
Image from US Navy, via Wikimedia Commons
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