The development of a set of principles to underpin GP commissioning is clearly a very welcome move, particularly if it speaks to both GPs and patients. Over the years, commissioning has become an all-encompassing term for a highly complex activity, yet it remains vague and poorly understood. While world-class commissioning gave the term more meaning and energy – at least to managers – this approach now seems headed for the policy graveyard. Hence, a new set of principles is needed to clearly articulate what GP commissioning should mean to those that deliver and receive care.
The BMA's proposals provide a useful launch pad for the debate. These principles cover a number of areas, stating for example that the professionalism of GPs in providing the best care possible to patients should not be compromised (for example by inducements from commissioners that may adversely affect patient care), and that GP practices should receive adequate resources and support to play a full and active part in commissioning services.
The role of practices in GP commissioning is also set out, rightly emphasising the importance of working in partnership with other health and social care providers to co-design services and deal with the wider issues of public health and health inequalities. It is reaffirmed that any savings should be re-invested in patient care, that GPs should not personally profit, and that effective public and patient engagement is key. The NHS is also earmarked as 'the provider of choice'.
The BMA's principles, as one would expect, primarily address the concerns of its own membership and set out what GPs and general practice should and should not expect from working with GP commissioning.
Currently, many GPs feel ill-at-ease with GP commissioning since it implies that they – rather than a primary care trust – will be responsible for 'rationing' care. A core issue for the BMA, therefore, is the way in which it seeks to absolve GPs of direct responsibility for having to make hard cost-conscious decisions that might lead to a compromise on care provision.
Unfortunately, the reality of this role cannot be easily ducked. However unpalatable, a key principle of GP commissioning is that it brings together GP practices that spend public funds to work collectively as members of the commissioning body that makes and implements cost-conscious decisions.
The dilemma is that GP commissioning won't work effectively unless GPs and general practices can agree to follow these collective decisions, some of which will undoubtedly lead to much argument and tough decisions. It will be a difficult path to follow, but a necessary one. Thought should be given to how to manage, convey and implement such difficult decisions – a process that might require a new degree of openness to patient and public involvement.
As the consultation on the government's commissioning proposals moves forward, setting the principles for GP commissioning and the roles of its key partners will be important. However, they will also need to be more outward-looking; GP commissioning should be driven by the ambition to make sustained improvements in the health and well-being of all people in the communities they serve.
The challenge to GP practices, and to members of GP commissioning consortia, should be to strive to deliver and secure the highest quality of care for their patients within the financial resources that are made available to them.
This blog also appeared on the British Medical Journal website