Primary Power

The involvement of non-GP clinicians in commissioning consortia was one of Nick Clegg’s 5 ‘non-negotiable’ demands in order to obtain the support of the Liberal Democrats in the health service reforms. David Cameron echoed, saying he understands the acute sector’s worry when hearing the phrase ‘GP commissioning’, and sought to reassure them that they will have their share in the decision making of the ‘new NHS’.

And yet the acute sector’s worries seem to have been fairly grounded. 51 Consortia Boards were examined, and so far not a single clinician from the acute sector was included. GPs and practice managers dominate, with practice nurses and the occasional non-clinical manager occupying the majority of remaining spots. Public health, social care and patients were also very poorly represented.

A concern was raised that as talented as practice managers might be, commissioning is a whole new skill. Spokespersons from consortia have said that ‘token appointments’ are not helpful either, whereas some are waiting to see if the government will demand ‘non-GP’ appointments, and are avoiding them as long as they are not mandated.

Hospital doctors are worried that commissioning decided solely by GPs will channel the budget away from hospital care. A further debate has been raised: how can public money be given to GP consortia, without any patient involvement or public accountability?

(HSJ, April 28)