Responding to the commissioning and patient involvement documents released today by the Department of Health, King's Fund acting director of policy Dr Richard Lewis said:
'These latest documents demonstrate progress in implementing health reforms but there remains an uneasy tension between a market and a central planning approach to improving health services. We need a much clearer picture of the overall vision, especially the extent of the role competition is intended to play in the new market.'
Commenting on specific policy initiatives, Dr Richard Lewis said:
The government is right to focus on the role of primary care trusts and commissioning in shaping service provision. However, in the current climate of structural reorganisations and financial deficits, doubts remain about whether there is the capacity for PCTs to respond quickly enough to counter the incentives to treat patients in hospital. The new tools they have to influence the way services are provided will need to be used extremely effectively if they are to have the required impact.
'There are some encouraging signs that PCTs will be able to incentivise GP practices to take on commissioning roles. However, the requirement for PCTs to reach financial balance is in danger of undermining this march towards practice-based commissioning – and practice-based commissioners will need to be assured that if they are successful in commissioning they will be able to use the savings they make.'
Community foundation trusts
We welcome the idea of community foundation trusts alongside other providers, such as social enterprise organisations, as they provide a solid model for engaging patients and the public. These are likely to be small-scale organisations however and so shouldn't be overly burdened by bureaucracy.'
Past initiatives to take the patient voice into account have been variable at best. Local involvement networks (LINKs) provide an opportunity to begin to get patient involvement right, especially by strengthening the relationship with Oversight and Scrutiny Committees. It will be important that LINKs are funded properly and that arrangements are in place to ensure they apply equally across the country.
'There needs to be much more consideration of how initiatives such as public petitions will work in practice and there is a long way to go to achieve effective local public accountability for new commissioning roles.'
Notes to editors:
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