Can we hear the patter of GP feet running away from any serious commitment to patient and public involvement in GP consortia commissioning arrangements? It certainly sounds like backtracking if we look at the BMA’s General Practitioners Committee statement issued on 10th September.
This makes no mention of the duty of patient and public involvement talked about in the White Paper:
Practices may feel it is appropriate to engage with their Patient Participation Group, where these exist, to ensure that practices are aware of patient views, and that patients have confidence in their GPs. Consortia may wish to consider holding open commissioning meetings so that patients and members of the public can observe the work of the consortium, with perhaps a facility for patients to submit their views on the commissioning process.
Compare that discretionary volte-face with what the GPC said less than one month previously. It was only on 18 August that their initial statement on consortia commissioning responsibilities was clear about involvement and accountability
Public and patient involvement should be integral to the work of consortia. Challenging decisions concerning treatment priorities may need to be taken based on a mutual understanding of the constraints of limited resources, and the obligation to use such finite resources wisely. The consortium must be accountable to patients and the public who will need to participate in such decisions.”
This inconsistency is shocking if their previous commitment is now void. Someone needs to challenge Drs Buckman, Vautrey et al on the GPC about that. And really it can only be clinicians who understand the value of patient and public involvement who can call their bluff.
Minimalist temptation; maximalist objectives
A concern is growing that GPs and managers they will take on to do the nuts and bolts of commissioning will be tempted to default to a minimalist BMA position instead of aspiring to something more inclusive in the spirit of the white paper(s), which after all talk about a duty of patient and public involvement.
If the GPC is to be believed, consortia will have to be no less than 500,000 people to be viable. If that is true, we can kiss goodbye to “total place” approaches working collaboratively with local authorities and the community. We suspect Councils will hate this “big is beautiful” approach to commissioning, especially in London. GP consortia should not be PCTs redivivus.
We know lots of GPs who liked the localism of Primary Care Groups which were about 100,000 populations because they could really make a difference at that level working across sectors and with the local population. We need that focus even in larger organisations to get financial and risk management scale.
The BMA, a trade union after all, asserts in its most recent commissioning guidance that “effective commissioning is effective general practice”. This is so wrong on so many counts: primary care is about so much more than general medical practice no matter how good it is and effective commissioning must stretch beyond health into addressing the wellbeing of a whole community.
Accountability process needs to be specified – quickly
Ministers are clear what they want where PPI is concerned. At the recent Kings Fund conference on GP commissioning Lord Howe, the Health Minister in the Lords, said:
Our proposals for GP commissioning will push decision making much closer to patients and much closer to local communities. They will ensure that commissioners are accountable to patients and communities in a much more direct way.
What we now need is a locally practical process that doesn’t become legalistic and confrontational to make sure that commissioning really is “accountable to patients and communities in a much more direct way”. That is an integral part of answering the question “Whose NHS Is It Anyway?”
Are there any takers?