We can claim then, that the private sector's involvement will not be limited to non-clinical areas. So what are we to make of this, and is there any way to counter the disapproving reaction to the name that we dare only whisper... 'the private sector'?
It is so difficult at times to cut through the absolutely polarised views that the worlds of public and private engender. I've seen good, bad and indifferent from both sectors – so how do we break out of the mindsets that constrain us? This for me is one of the biggest challenges in setting up GP consortia.
Primary care trusts have been excellent at commissioning some services, average at many and sadly poor at a few – this is usually due to a host of systemic reasons and not necessarily a reflection on the staff. Don Berwick, the Chief Administrator for Medicare in the USA, tells us that if we carry on with the same processes we will get the same results; can we afford to take that risk? I think that we can't afford not to change. The whole premise of these reforms is that they put patients and clinicians in the driving seat, so we'd be daft to send them on their journey with their hands tied.
First, we must begin to differentiate those functions that have worked well from those that haven't. We need to focus on the functions rather than the 'bad' private vs 'good' public argument. Let's look at these areas through a new lens.
I recently met with MS Society and Parkinson's UK who have come together to develop a commissioning group. The work they have done is like a breath of fresh air – these groups have so much to teach consortia. For as well as liberating the NHS, we need to liberate the third sector, which has the creativity and ability to truly make a difference. When we focus on the private sector we must look more widely and consider who is best placed to deliver first-class commissioning support. We must also lift our sights above current geographical boundaries, as many of these functions will be most cost effective at scale.
This brings us on to small versus large consortia. For me, small is beautiful: smaller consortia tend to have well-defined clinical relationships and networks that are able to deliver the most change and innovation on the ground. But surely we can have the best of both worlds, with smaller groups forming one consortium with localities or alliances? The support services could sit over these groups, hosted by one or other consortium, helping us to break away from the notion that all support services are provided to just one area.
The duties and responsibilities of consortia are becoming clearer, and soon they will be able to look closely at all the functions they need to support them. I would argue that some functions, including referral management, can only be done by the members of the organisation: you cannot delegate functions that reflect your behaviour as an organisation. However, other functions can be done from afar and by many different providers. Let us get the debate back to who is best placed to deliver these necessary functions.