Two documents emerged yesterday which take the issues in the white paper Commissioning for Patients a bit further. I typed that title in the first time as “commissioning for payments” – but it amounts to the same thing really. Both documents are important for what they do say and what they don’t say.
Q&A and Dear Colleagues
Many people are -rightly – asking questions about the proposed NHS changes around GP commissioning, accountability to patients, work with local authorities and how all of this can happen while PCTs are being wound down. This Q&A paper just out from the Department of Health is designed to answer those questions. It is undated but was created on 22nd September, so still warm from the central policy oven.
In addition, Mr Lansley wrote to all GPs yesterday giving these “dear colleagues” more detail about key issues around commissioning. It takes these forward but does not necessarily provide the answers that many GPs and the rest of us are seeking.
Cornwall and Kingston might show the social enterprise way
Note the big fudge in Q10 of the Q&A from DH about employment status of commissioning consortia. There is no way the circle can be squared with NHS pensions and Pay &Conditions. It will be TUPE for existing staff, but the free market for new joiners. This is still a big disincentive for many. But it is no less than the rest of the non NHS workforce faces, so some growing up needs to be done.
NHS Cornwall has put its community staff (I assume with their consent!) into a Community Interest Company (CiC), which may work down there where there is little market contestability. I think this would invite business disaster in a metropolitan area. Kingston PCT in suburban London has done the same, so that will be a good test of viability for this form of mutuality. Can they become the “John Lewis” of community services? Time will tell.
Nurses could lead us to something better – will they?
You can watch Mr Lansley seeking to mollify the biggest chunk of the workforce at the Royal College of Nursing on Wednesday in an hour’s webchat with RCN CEO Peter Carter. Takes the issues a bit further (maybe).
As my Dutch friends say, “ We are still confused, but at a much higher level”.