It's actually quite open. The white paper makes specific reference to the idea of outsourcing the commissioning functions (commissioning is NHS-speak for buying the various treatment and services required to look after patients). At present, commissioning is being performed by the Primary Care Trusts - they are responsible for buying all NHS services for their region. There are a couple of hundred PCTs at the moment; the best guesses I've seen are that there will be around 500 or so GP Commissioning Consortia.
That said, there are some pretty serious issues with this. The Government claims that these GP commissioning cosortia are going to be more efficient than the current PCT commissioning model and thereby save money, while providing more effective service to the patients.
Unfortunately, there's not a lot of evidence for this.
The Nuffield Trust took a look at GP Commissioining in California - a similar model to what they want in the UK. They found, unsurprisingly, that most of the consortia were struggling to survive as a commercial enterprise. The ones that were performing well were the ones who had hired experienced and competent managers and had invested heavily in infrastructure, especially IT. These consortia were very good (and actually quite efficient). But that efficiency and effectiveness required significant up-front investment.
And, in the UK, if you want to find capable staff with experience in commissioning, then you will probably have to hire them from the (now defunct) PCTs. It's quite possible that at least some of these people will recieve sizeable redundancy packages then get rehired at about the same salary to do basically the same job but for a smaller population. I'm not sure how that is more efficient. If I were forced to say why, I would say that the underlying drive behind these changes is the ideological belief that the private sector is inherently and always superior to the public sector. Unfortunately, the evidence doesn't really stack up to support that belief as a universal claim.
On top of this, they are introducing a bunch of changes to performance targets. These changes are being rushed in. To give some context, a similar change was introduced by the last Government in the ambulance services. The changes were announced in 2005, worked on for a few years, then formally introduced in 2008. By that time, most services had undergone fairly radical change and were coming pretty close to target.
A new set of changes were announced late last year, to be implemented by April 1st. As of today, some of the fairly important details have still not been announced, so the services are a bit unsure what exactly what targets and standards they are going to have to achieve in three months time. To meet these targets will require some fairly substantial changes in operational practices. So the commissioning of ambulance services is having to go ahead without knowing what the targets will be, what effort will be required to meet them and how much potential savings can be generated from more efficient operation.
All in all, it's a bit of a mess and seems incredibly rushed. My guess is the Government is trying to achieve everything it wants to within one term...
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