Hospital doctors: the reformed NHS needs you!

Along with nurses, public health specialists, social care and allied health professionals, patients and the general public, doctors working in secondary care have been invited to contribute to commissioning as a result of announced revisions to the government's reforms.

Hospital doctors keen to get involved have a range of options:

  • join the board of next door's clinical commissioning group (but not their local one)
  • join their local clinical senate
  • join a clinical network for their specialty.

Some of this will depend on the passage of the revised Health and Social Care Bill through parliament.  But if these proposals do make it through intact, what would each option involve?

With the first option, doctors working in secondary care can join GP colleagues as full members of the clinical commissioning groups responsible for commissioning the majority of NHS services. This would involve all the different functions and responsibilities summarised in that one word 'commissioning' – including needs assessment; reviewing services; strategy and priority setting; local rationing decisions; contracting; procurement and performance management.

But importantly, hospital doctors won’t be able to do this for their local area. The government's logic is that local hospital doctors would face too great a conflict of interest in making commissioning decisions about secondary care in their own places of work. But will many hospital doctors be interested in getting involved in commissioning services away from where they work?

With the second option, hospital doctors can exert influence directly on their local patch – providing expert advice and clinical input to service reconfigurations and the moves towards greater service integration (including potentially contentious local issues such as service closures). Clinical commissioning groups in the local area – and there are likely to be several – will be expected to follow their advice.

The government claims that the final option open to hospital doctors will allow them to take a stronger role in commissioning through both existing and new clinical networks. This would enable them to work on issues such as defining local pathways of care, although further work is being done to determine the precise range and function of clinical networks. With some networks currently experiencing major budget cuts and uncertain futures, this announcement may give clinical networks more confidence about their future.

If you were – or are – a hospital doctor, which option would you choose?

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Comments

#475 Kulbir Mann
Surgical registrar

I welcome the advice of secondary care input into primary commissioning but how much help can you truly be if your experience base is wayward? Theoretical clinical networks not based upon local primary need will provide a framework but not a true tailored pathway. If you remove the doctors with specific local interest then you will limited numbers. However at least it is a step in the right direction.

#476 Raj Patel
Medical Director
NHS Greater Manchester

Even before the pause, I was ready to recruit an associate medical director (specifically from secondary care) to help with service re-design across Greater Manchester for Gtr Manchester PCT cluster. Would be delighted to speak to any hospital doctor interested in the role. I have a job description ready.

#477 arun chopra
Consultant Psychiatrist

Has this been thought through? I work for a large Trust that covers different geographical and commissioning areas. I work for a part of the Trust that serves one area. Would I be eligible to be part of the commissioning group for the area that I don't provide a service to? Wouldn't that introduce a conflict of interest? And if it does- then would I really be interested in commissioning for another area and group that I have no professional contact with? The motivation to be involved is to make services better locally.

#479 Elizabeth Evans
former medical advisor

In my experience working with peer review of referrals, consultant expertise is invaluable. But consultants were often unwilling to give time to advise GPs when they felt the hospital sector was calling the shots (pre reforms) and some will be unwilling when GPs are truly commissioning. There will be some clinical areas where relationships between GPs and consultants will rapidly deteriorate.

#482 Suparna Das
Director
e3 intelligence Ltd

Fully agree with the title of the blog post but, unfortunately, most hospital doctors are not ready for such a role. I say this from experience, having been an NHS consultant anaesthetist who has changed career to management via roles across three PCTs and a managed clinical network. GPs, as self-employed business people, have an incentive to negotiate, influence and work closely with PCT commissioners and understand budgets and finances. Although initiatives like practice-based commissioning weren't taken up widely, they did help this process along. On the contrary, hospital doctors don't usually have any such incentives to pique their interest in commissioning.

#491 James Bunt
Interim/consultant
Gordian Management

Interesting debate - does it however illustrate the need to "break the pot"? Primary and secondary care are useful descriptors but do they work as a commissioning concept? For example is there more common interest between GPs and certain medical specialities (for example on diabetes pathways). If the organisations evoloved to address these clinical links then conflicts would be reduced and integration supported. Too radical?

#505 John Doe
Healthcare Worker

Much of this dialogue up till now has been based on the assumption that the state (i.e. the taxpayer) will, come hell or high water, pick up the bill directly for any healthcare services on offer, whoever provides those services and whoever receives them. This has up till now been "the British Way."

But, we must not lose sight of the fact that it is the UK taxpayer who picks up the tab on behalf of all, whether or not they are taxpayers or the dependents of taxpayers.

We badly need to start thinking laterally and recognise that the NHS should really be a safety net rather than an untouchable all-singing all-dancing entity. Sadly, however, while the phrase “private health care” is not an expletive, some behave as if it is.

Taking the analogy of local authority housing, this is available to all of us but despite this many choose to buy their own house because they can afford to do so and want something more. Putting it bluntly, some people will pay up even if they don't have to.

Could this apply to healthcare? We all agree that the providing of healthcare services costs money, so if we are going to be able to get more money into healthcare than is currently possible with our almost 100% reliance on HM Treasury alone to foot the bill, we simply have to find ways to get the taxpayer to pay out more.

This does not have to be about income tax alone. Those clever chaps at HM's Treasury should surely be able to think up a few ways to persuade those people who can afford to do so to invest in their own health, and pay for an operation instead of a 2nd holiday. One way to take this forward might be to give companies tax breaks for any comprehensive healthcare policies that they arrange for their staff. In such ways one would then start to ensure that the safety net function of the NHS is not exceeded and those who cannot afford it receive care, which should surely be its prime noble intention. If British people have to think a bit more about how they should service their healthcare needs, why is that such a bad thing? They might start valuing their health a bit more.

Sorting all this out needs dialogue, and requires all healthcare workers to be involved in the debate, including both GPs and hospitals doctors - and all need to keep an open mind. The dentists seem to have got their already…..

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#560 Tom Lake
Software Engineer

Conflicts of interest are rife and embedded in the proposed Lansley system. It appears to be riddled with conflict of interest in the unaccountable GP commissioning groups. The hospital doctors will rightly feel cheated over any influence or control over their own work or practice. It is clear that the end result of this is going to be a disaster, for patients and especially for GPs who will eventually end up as employees after the big bust-up.

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