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Editor's blog Monday 11 October 2010: Battleground NHS and the wary privates

So, what have we learned in recent days?

On Saturday, Health Secretary Andrew Lansley told BBC Radio 4 Today that the issue for GPs is not the goal of policy - greater GP involvement in commissioning and decommissioning services - but its implementation.

Ahem. He also quibbled with interviewer Sarah Montague’s description of “a huge amount of concern” in NHSLand about the White Paper reform: an attitude which suggests strongly he and his team don’t read much beyond the first two paragraphs of any White Paper response.

Mr Lansley insisted that many responses welcomed ”the vision” of Equity And Excellence. Which at the absolutely top-line level is correct: people do think patients should be more involved in decisions about their care; that health outcomes shold be the crucial measure of service effectiveness; and that clinicians should be more involved in commissioning decisions.

The problem with visions is turning them into realities. Some visions are utopian dreams; others are hallucinations.

Mr Lansley The Liberator emphasised the pace of change was spread across two-and-a-half years, indlucing two full financial years: “in 2011, (we’re) looking for pathfinder consortia across the country and learning networks between them, and a full year of shadow running in 2013”. He emphasised how practice-based commissioning consrtia’s efforts had been frustrated because they “were not given the necessary support by PCTs”.

No risk of NHS break-up and privatisation – Lansley
Mr Lansley also disagreed with concerns in various White Paper responses that this could be beginning of the break-up of NHS.

Risk of NHS break-up and privatisation – Healey
This morning, we found that shadow health secretary John Healey feels that fear of NHS backdoor privatisation by US corporations is a productive line of attack on the White Paper.

He told The Independent, ” The new NHS will be open to all-comers and all providers. Big private companies – including American companies – are ready to move in. GPs will have to hire them to do the commissioning on their behalf. At the moment, a typical PCT has 2,000 clinical and 200 non-clinical contracts. The family doctor, however bright and interested, is not going to do that.”

Mmmmm. There are big questions about the private sector’s willingness to rush in where angels may fear to tread. Many private sector providers of commissioning services – aspirant or actual – were deeply hacked off the by framework for procuring external support in commissioninign (FESC) process.

Privates on parade? Perhaps
Anecdotally, these private providers’ levels of certainty and confidence about the new market are very low. They, like we, still do not know how many GP consortia; how they are to be constituted geographically and membership-wise; and crucially, what their management budget will be. In the absence of these key pieces of information, they are not going to be investing.

In the interim, private sector commissioning providers might be looking at Tribal, whose early attempt to staff up to grab the market must now be feeling a bit frightening in the light of their recent profits warning. Stories reporting this also revealed that the company ”had managed to reduce staff numbers and overheads in its health advisory business”.

Still, Health Service Journal will have had a nice, needed financial boost from Tribal’s post-White Paper recruitment advertising.

While Tribal’s half-yearly report to shareholders revealed that the company has secured refinancing to February 2015, seasoned NHS observers will reflect that Matthew Swindells’ ship-jump to Cerner was nicely-timed. Tribal’s financial presentation suggests that more positively, they have a “position established as a leading provider of commissioning services to the NHS; increasing demand for hospital transformation work; and think the recent White Paper likely to create significant medium-term opportunities”.

Healey also remarks, ”GPs trained as doctors, not managers or accountants. Most want to be family doctors rather than financial managers”.

In framing this part of his argument, Healey is following The Economist’s dicutum to “simplify, then exaggerate”.  The majority of GPs remain small businessmen, who have a certain economic numeracy – or hire people who do. Clearly, GP commissioning consortia will be operating at a different order of magnitude.

There are perhaps more interesting issues to tease out regarding the White Paper’s plans for general practice. One would be GPs’ willingness to act corporately in consortia (considering the wildfire popularity of referra management centres); another their desire to lose popularity by making tough decisions about closing services or rationing access.

But these are policy geek questions. Most national newspapers struggle to make policy geekery interesting.

Battleground NHS
More to the point, Andrew Grice’s article reports that Labour leader Ed Milliabnd told Mr Healey, on giving him the health portfolio, ”This is the big public services battleground for Labour over the next five years".


Being a battleground of any kind scarcely sounds wildly appealing. A political battleground may involve less overt use of actual munitions.

It will, nonetheless, be a messy place for the new GP commissioning consortia to be born. To extend Mr Milliband's metaphor, there will be casualties and there will be pollution.

We also learned today that the Summary Care Record is to be allowed to survive the cull of NHS Connecting For Health, in a minimalist form, featuring only “a patient’s demographic details, medications, allergies and adverse reactions”.