This is the paper the programme refers to: Towards Service Excellence , on the Health Service Journal website.
The key points are:
This document is a clear statement of intent to create a market and privatise the bulk of Primary Care Trust (PCT) functions.
It says, p. 23 “The NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to freestanding enterprise.”
PCTs have about 2-300 different functions. Their role is to plan and manage care outside hospitals e.g. community services like district nursing, physiotherapy, psychology etc. They also manage the ‘internal market’ which is the contracting between GPs and hospitals. This was set up in 1991 in order to remodel the NHS fit for private companies to move into the provision of care. Before the internal market there was no need for contracts between GPs and hospitals and GPs were free to refer their patients to any NHS consultant they wanted. The latter-day emphasis on patient choice has to be seen with a sense of bitter irony that converting the NHS to a market will mean that patients and GPs will never again have that freedom.
Part of their work is ‘commissioning’, for example, we commissioned a fertility service from our local hospital. This means that we have agreed that when a woman needs fertility treatment we GPs will arrange all the preparatory investigations for the woman and her partner and the hospital will provide an agreed level of management. This way the women don’t waste time having investigations repeated, the fertility specialists know what to expect when a woman is referred, and the NHS saves money because the process is efficient. The role of GPs was to sit down with the hospital specialists and a couple of people from the PCT and hosptial management. Most of the work involved in commissioning is administrative.
This report suggests that this work will be subject to a competitive market. The commissioning services described in this report (page 14) are comprehensive, i.e. they include; needs planning, design of services, data management, monitoring of outcomes, contracts i.e. absolutely everything that commissioning involves. Only the 7th ‘Back office functions’ is in my mind ‘commissioning support’. At the end of the Channel 4 news report it states that a department of health spokesperson said that only ‘back office functions’ were being outsourced.
The only services that the report suggests would be actually commissioned by GPs would be, “Third sector contracting, learning disability services and localised community services, such as those that focus on vulnerable groups with the poorest health outcomes are sensitive to local knowledge and should be procured at local level, supported by specialist commissioning expertise” … “However, even where it has been decided that clinical services should be most effectively carried out at a local level there may still be elements such as the technical aspects of procurement that are most effectively carried out at scale.”
In Appendix A (p.3) there is a table outlining the capacity and capability of ‘other [than the NHS] sectors’ to take on commissioning functions. This shows that the government believe the private sector to be capable of taking over the full range of commissioning functions. Private sector companies interested in this work include KPMG, United Health and others who have been lobbying the department of health for years. Earlier this year the UK division of US health insurance giant UnitedHealth sold its GP practices to The Practice, focusing instead on providing commissioning support to GP consortia. UnitedHealth also own a program called Script Switch, which automatically suggests cheaper alternatives when a GP types in a prescription. It can also be used to restrict the range of prescribable drugs. UnitedHealth have identified that commissioning, rather than general practice, is where the profits are. They have a history of restricting care in the US where they underpaid millions of people in New Jersey, Florida and California after determining insurance reimbursements for out-of-network care.
The report says (p.18) without any qualification, that CSO will save 25-50% of PCT costs. Presumably this just means they will just cut costs by 25-50% We’ve been given £25 per patient for admin in our CCG compared to the £60 our PCT had.
The government’s insistance that they are not privatising the NHS can no longer be justified. They have been dishonest.
The reason this matters is because, as it stands, the NHS is the most equitable and efficient universal healthcare service in the world.
Privatisation of healthcare services is associated with increased inequity, reduced access at a time of clinical need and increased costs due to the transaction and adminstration burden associated with running a market.
At a time of austerity we cannot afford to gamble with an experiment in privatising the NHS, nor can we afford to risk the care of our most vulnerable patients with an untested healthcare market.
The Privatisation of GP Commissioning by Richardblogger.
The Privatisation of GP Commissioning by Richardblogger (added 09.01.2012)
Further privatisation is inevitable under the proposed NHS reforms. Clive Peedell BMJ
Full text of letter sent by Dr Laurence Buckman, chairman of the BMA’s GPs committee, to 22,000 family doctors in England: