GPs 1 – 0 Mandarins
Posted: 8 November, 2010 by Andrew Craig
The dismal performance of the mandarins (Nicholson, Hakin, Dyson and Colin-Thome) in front of the Health Select Committee on 19th October was completely outclassed by the GP leaders (Steve Field, Richard Vautrey, Jim Kingsland and Mike Sobanja) on 2nd November playing away at the HSC ground. The result: GPs 1 – 0 Mandarins, which puts the docs back at the top of the public involvement league table.
Here are some highlights from the accountability questions.
Rosie Cooper MP (Lab – West Lancs): Would you be happy if patients and/or councillors were on consortia boards? Would each of you be happy?
Michael Sobanja (NHS Alliance): I would say it is an absolute pre-requirement that every general practice commissioning group has public representation on it and I would go further and say there has to be a mutual lock with local government to make sure that their public health activities and the commissioning plans of GP commissioning consortia are complementary. But, absolutely, I think that should be a key requirement.
Rosie Cooper: Can I ask each one of you that?
Dr Richard Vautrey (BMA General Practitioners Committee): I think any emerging GP-led consortia would be foolish not to involve patients in a meaningful way. Over the last––
Rosie Cooper: On the board?
Dr Richard Vautrey: We don’t know what the board structures are going to be yet but I think they––
Rosie Cooper: At the decision-making point?
Dr Richard Vautrey: Decision-making, yes, clearly.
Rosie Cooper: At the decision-making point, not to be considered?
Dr Richard Vautrey: Yes, because the––
Rosie Cooper: Not throwing a snowball at a moving truck?
Dr Richard Vautrey: Yes, because if they fail to do that, GP-led consortia are going to have to make very difficult decisions about prioritising one service against another. If you don’t involve patients in that discussion and in that decision-making process, then you will end up with conflicts and local campaigns.
Rosie Cooper: You are going to get that.
Dr Richard Vautrey: You’re going to get that anyway but it has to be seen as comprehensive as possible.
Rosie Cooper: But I’m asking a question about the people being there at the point of decision making, not and/or, not “and to be consulted”, but with a vote at the point of decision making.
Professor Steve Field (former Chair, Royal College of General Practitioners): If you want my answer, I would say “Yes”. There are different ways of doing that, but I do believe the public should be on the boards of the consortia. But I think there needs to be much more effective work alongside that in the consortia linking across to local government where the public really truly do have much more input in designing local services, which is why I said earlier on I do like the link with local government.
What we must not do is slow down change. So you need the public to be on board. If you look at Rugby and places where they have had issues with their local hospitals and moving from Emergency Departments to Minor Injuries Units, the way you effect change is to get the public on board to really understand why you need to change things and listen to the public more effectively. I do think, actually, we have the opportunity to do that. In some areas it has been really good to date but we need to get that everywhere.
Dr James Kingsland (National Association of Primary Care): I would go further. I would say of the 8,230 micro commissioning systems that will be in place, practices who have budgets should inherently have a patient voice as part of their everyday practice. The commissioning board that develops from the aggregation of those practices is an aggregation of those practice-based patient groups. I would like to see every general practice have a strong voice from a patient representative organisation.
Dr Richard Vautrey: And it is that model that my own group is developing.
We welcome this frank exchange and the statements on lay participation in decisions about commissioning from GP leaders. As Dr Kingsland confirmed when he spoke about 8,230 micro commissioning systems each having a patient representative organisation, it is all about what happens in the practices at the grass roots. That is where the investment in involvement will pay the greatest dividends.
We also find it curious (or maybe not given the factionalism of GP politics) that Dr Vautrey was positive about lay involvement in decision making about commissioning in his response on 2nd November, but the GPC’s guidance (and he is vice chair of the GPC) last month was running away from it as fast as they could. Is anyone checking GPC policy for consistency and continuity?
But we have to say that Rosie Cooper nailed the big issue yet again at the end of the exchange. It was, is and always will be about who has what share of the power and how they are able to exercise it. Her words speak for themselves:
Rosie Cooper MP (West Lancs): A strong voice is not what I am talking about. It is a vote at the table. You can be as strong or as quiet or as noisy as you like. The only thing that matters is when you’re at the table and you’ve got a vote.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations.
