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Commissioning a Patient-led NHS

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The phrase ‘Commissioning a Patient-Led NHS’ refers to a now infamous letter sent out by former NHS chief executive Sir Nigel Crisp to all health service managers in July 2005.

That letter announced details of a radical shift of primary care trusts from being providers of services to commissioners. It also outlined large-scale mergers of existing health service organisations.

The direction of the government’s plans was not a complete surprise to those operating the NHS at the coal face, but the advanced nature of the plans, and the precise timetable were. It appeared that the government had a very detailed plan of action that had been decided on without consultation with managers or staff.

Following an outcry from staff and unions, the Department of Health backtracked and said PCTs would not automatically lose their role as providers of services if they wanted to keep that role. It also apologised for the lack of warning on such radical changes to come.

Nevertheless, many of these changes are now going ahead. The mergers have resulted in England’s 28 strategic health authorities becoming just 10 in July 2006 and the country’s 303 PCTs will become 152 from October 2006. This has meant many jobs have been ‘reconfigured’ and lost.

One of the ideas behind Commissioning a Patient-led NHS was to have PCTs contract out service provision to GPs, existing NHS bodies, foundation trusts, NHS staff setting up their own organisations, and the independent and voluntary sectors.

The involvement of the independent and voluntary sectors has proved to be controversial and many community nurses raised fears about who would be employing them and would their NHS employee status be affected.

The original letter also insisted there be a faster implementation of practice-based commissioning throughout England.

Practice-based commissioning means GP practices or clusters of practices take on responsibility for commissioning from PCTs. They are given a budget, based on data from their PCT, to pay for all episodes of patient care in both acute and community settings.

Those involved can keep any money they save and reinvest it in improving their own services, but sign up to the scheme has been slow and it is highly unlikely that all practices will be involved by the end of the year, which is the government’s intention.

The government is now consulting on how PCTs will commission services and has proposed that private companies can apply to be put on a list of organisations from which PCTs can choose when contracting out their ‘management’ services as well as their ‘support’ services.

Updated: September 2006

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