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?