Commissioning for the future: Learning from a simulation of the health system in 2013/14

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The reforms set out in the coalition government's White Paper have wide ramifications, particularly for GPs.

NHS Lincolnshire decided to help GPs to understand the issues and behaviours that might emerge as a result of the reforms by running a simulation exercise with The King's Fund. Commissioning for the future offers observations about individual and organisational behaviours and about system dynamics as a whole.

The participants were provided with a briefing for a fictitious county – Bigshire – that was not dissimilar to the environment in which they were working. In order to create a realistic scenario, participants represented organisations across the whole health system, including:

  • GP consortia
  • NHS and private provider organisations
  • the health and wellbeing board
  • HealthWatch
  • the NHS Commissioning Board
  • Monitor
  • CQC.

The simulation took place over a day, representing a year of simulated time. Throughout the day, regular interventions were published and participants were required to react to them. Some interventions were applicable to the whole sector, while others were specific to one organisation or type of organisation.

Observations on the day and reflections provided by the participants are pulled together into a number of key themes – the behaviours and support needs of GP consortia; the role of the NHS Commissioning Board, Monitor and CQC; the role of the NHS and private providers; the role of the health and wellbeing board and HealthWatch. The main observations were:

  • the personal and organisational development challenge for GPs is significant
  • cross-consortia relationships were slow to develop and consortia struggled to manage their constituent practices
  • the role of the National Commissioning Board expanded rapidly
  • the dominant acute provider was absorbed by financial planning and very internally focussed
  • public health and the patient voice were largely ignored as the health and wellbeing board and HealthWatch became marginalised.

This simulation provides valuable insight into some of the potential risks and opportunities of the new regulatory and management structures being implemented.