War is too important to be left to the generals. And commissioning is far too important to be left to the GPs. The public and service users must share the driving seat with them and the other “professionals” in order to influence and lead reform from the user perspective and in the public interest. That’s the essence of good governance in commissioning and that’s why we have a big reservation about the Functions of GP commissioning consortia which describes the Government’s vision of their proposed statutory functions. Unless the top level governance arrangements it outlines for consortia are changed, it will amount to “key decisions made about me without me”.
The key consortium duty is: “To commission healthcare to the extent the consortium considers necessary to meet the reasonable requirements of patients registered with the GP practices who are members of the consortium.” The phrase “to the extent the consortium considers necessary to meet the reasonable requirements of patients” is not sufficient to deliver Mr Lansley’s mantra “nothing about me without me.” To have validity, we need a governance form that embeds the patient experience and public involvement in the governance process.
Fig leaves for boys with balls not wanted
Changing the governance arrangements to something more representative that positively impacts on commissioning behaviour does NOT mean packing the consortium “board” with a new species of non executive director. Some have argued for this, but we do not support it. Top down solutions for patient and public involvement do not work. Just look at all the fig leaves around PCT Boards and Health Authorities before that.
MAC partner Caroline Millar cautioned against playing the board room numbers game at the Health Select Committee last month and argued instead for a bottom up representation of local lay leaders around the top commissioning table:
“Clinical and executive status and expertise trumps lay and public status in very many cases. This will only be changed if there is a significant shift in attitudes and behaviours of boards. As this will be new territory for many GP commissioners, there are opportunities to make such changes from the outset.
In a “bottom up” model, we would see public and patients in practices represented on the board. There has been much emphasis on clinical and managerial leadership in GP commissioning and we would like to see this complemented by strong lay leadership which is valued and supported by commissioners and nationally. Lay leaders will need recognition, support, training and rewarding – just like their opposite numbers.
No matter how boards are constituted in terms of the individuals who sit on them, the important thing is that there is a constant onus on the whole commissioning process to make decisions based on proper health intelligence gathered from a range of sources of which public and patient views and experiences form an important part. “
Lay input to make an impact
This is the key issue to resolve – how to get public and user views into every aspect of commissioning from across the consultation table to around the boardroom table so that it actually makes a difference. This is a challenge that can and must be resolved locally. How it is done does not have to be the same in each consortium, so long as it is done and the end results are comparable. The National Commissioning Board has a remit to issue guidance in this area and we hope that it will.
Once this issue is resolved, then the other positive things in the new consortium functions document – and the Health and Social Care Bill itself – about involvement will become much more coherent.
At the moment, the positive statements about PPI and engagement are still fragmented because they are not collectively hooked into the decision making process at the top commissioning level. That must change.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.