Over the past two years, the world class commissioning programme has attempted to measure the quality of commissioning and encourage improvement. The results of the second annual assessment, due to be published in July, are expected to show that PCTs have made improvements since 2009.
However, research published today on building high-quality commissioning, shows that PCT managers believe it would take at least another three or four years to develop truly world class commissioning. Essential capabilities – for example, analytical and commercial skills – are in short supply in the NHS. As a result, managers have increasingly turned to the private sector for support with commissioning.
Current plans to give GPs greater commissioning responsibilities can be expected to amplify this trend. If PCTs have struggled to 'do it alone', this will be all the more true of GP consortia, which will be smaller and have less commissioning experience. In order to be effective commissioners consortia will need support.
The Secretary of State has indicated that consortia will be able to seek support from various organisations, including PCTs, councils and private sector firms. It is not clear how effectively PCTs, operating with a much reduced commissioning workforce, will be able to compete in this market.
These changes make the world class commissioning programme, as currently structured, largely redundant.
Let's not throw the baby out with the bath water, however. Although the assurance process has been criticised for being overly bureaucratic, our research suggests it has been effective in giving commissioners a clearer idea of what high-quality commissioning looks like. It is important that as commissioning responsibilities are transferred to GPs, the government develops new means of assuring the quality of commissioning, and that there continues to be support for the development of commissioning skills.
The government will also need to put appropriate safeguards in place to protect public accountability and manage the financial risks, particularly if consortia choose to outsource their commissioning responsibilities to external organisations.
The government's ambition to improve the use of valuable clinical knowledge in the commissioning process is a laudable one. If commissioning is to become world class, the challenge will be to create an environment in which GP consortia can work with PCTs, private sector firms and other external organisations in an effective and cost-effective way.