In Views

Follow this topic

Bookmark

Record learning outcomes

Clinical commoissioning is becoming a one-way street
with only GPs having access to it

Clinical commissioning is like Marmite, people either love it or hate it; there is no middle way. The health secretary, Jeremy Hunt, clearly loves it. In June he gave a major speech at the Health+Care 2014 conference. He spoke at length about GPs and the hard work they were doing, and how grateful and €excited€ he was. (I lost count of how many times he used that word or its variants).

He said that clinical commissioning meant that more innovation was possible at local level than under the primary care trusts and that, all over the country, clinical commissioning groups were using the powers and freedom they had to take big steps forward in commissioning.

I got the very strong impression that, when it comes to clinical commissioning, Mr Hunt wears a particularly large pair of rose-tinted spectacles.

One example he gave of these big steps forward was in mental healthcare when, as everybody knows, mental health services are in meltdown.

Future

According to him, the future of commissioning is very simple, and this is what is at the heart of the so-called reforms: he wants CCGs €to become accountable care organisations,€ to €take responsibility for the entire delivery of healthcare for the populations that they represent,€ and he wants things to be based on a patient capitation structure, such as is used in health organisations in the USA.

All this was in the first four minutes of a 30-minute speech. But, I wondered, how much of this actually represented government policy or, perhaps more pertinently, Conservative Party thinking?

Two words struck me: €accountable€ and €represent€.

Let's be clear: clinical commissioning groups represent nobody but themselves. They are not elected, they propose no manifesto, and they have no mandate.

Represent, Mr Hunt, really? And what about €accountable€? To whom are CCGs accountable? To the populations they supposedly represent? But wait a minute €“ what about the growth of patient forums? Aren't they meant to hold CCGs to account?

Struggle

Sadly, patient forums, it seems to me, have been struggling to develop a coherent voice. They are usually ignored, and have absolutely no power.

Words like €accountable€ and €represent€ are weasel words, Mr Hunt. They are meaningless, cheap and becoming more tawdry by the day as they are overused by politicians who don't actually want to make any commitments they might be judged by.

Pharmacy is still waiting for it's invitation to the healthcare party

And then there's this idea that future funding of the National Health Service would be based on capitation. Mr Hunt gave Kaiser Permanente in the United States as an example of a standard of healthcare delivery to which the NHS should aspire. The USA? That paradise where healthcare is universally available to all citizens irrespective of their ability to pay (or not!).

The US healthcare system is run by the financial services sector for the benefit of the financial services sector. It is the most expensive system on the planet and many people do not have access to healthcare under it. The only benefit from a shift in that direction in Britain would be for the financial services sector, organisations that have demonstrated consistently just how worthy they are of our trust and respect (or not, again!) €How accountable would they be if they were entrusted with the management of capitation fees?€

One of the most frustrating and short- sighted problems with clinical commissioning is the lack of involvement by pharmacists and the fact that pharmacists have found it almost impossible to manage to get services commissioned at any meaningful level €“ so much for the government's much-touted commitment to competition and innovation.

There was no mention of pharmacy or pharmacists in Mr Hunt's speech until, in responding to a question, he said: €There were those words I forgot to put in my speech but they were there in my mind: Pharmacy! Pharmacy! Pharmacy!€ (He actually punched the air three times as he said this.) He added that pharmacy was an important part of the changes needed €because we know that one in seven visits to A&E departments could be avoided if someone went to a pharmacist.€

I won't bore you with any more of this patronising drivel. Pharmacy is clearly so important that the Secretary of State for Health forgot to mention it. GPs, on the other hand, got plenty of mentions.not to mention it. GPs, on the other hand, got plenty of mentions.

Rhetoric

Frankly, I couldn't care less how many mentions we got in a speech of such inanity. But I am concerned that, despite the rhetoric, despite the opportunities for innovation so highly lauded by Mr Hunt, despite the very obvious need for better use of medicines, pharmacy is still waiting for its invitation to join the healthcare party.

There is the possibly apocryphal tale of a conversation between a GP chair of a CCG and a pharmacist: €I don't know where you get the idea that GPs would commission services from pharmacists,€ the GP is supposed to have said. €Clinical commissioning is for GPs. You had better get used to it.€