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Jane Warner

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‘Is the commissioning plan an April fool’s trick?’

It’s that time of year again when I find myself in a quandary about April Fool’s Day.

You see, I sense there might be an outside possibility that the Department of Health’s operating framework for 2008–2009, which covers the commissioning and procurement of primary care services, may be a serious document, not an April fool’s trick.

According to the framework, PCTs have, at most, eight or nine months left in which to complete their procurement process, award contracts to providers and ensure these are verified at strategic level. This is to be achieved while trusts are still going through the hiring and firing involved in reducing their number from 303 to 152, which started in 2006 as part of the reorganisation of PCTs.

The framework is a chance for clinicians to take control of commissioning local services, supporters say. We have an opportunity to influence and innovate. And to their credit many have risen to the challenge, for instance by setting up services to reduce hospital admissions.

But why have so many other clinicians done little more than form focus groups and project teams? There are probably so many near-identical PowerPoint presentations on procurement and commissioning doing the rounds that if laptops were sentient they would hurl themselves against conference room walls in frustration.

The answer, I suspect, is that most of us already do our best to respond to local health needs in flexible and innovative ways. We know the populations we strive to serve, often from cradle to grave. We have evidence that patients are very satisfied with the services they receive.

No nurse could ever disagree with a wish to improve health outcomes but, regardless of the framework, I predict, at the start of 2009, finite resources will mean the only real change will be an intensification of the ‘inverse care’ law whereby the most needy – who already live in under-resourced areas and have no voice – receive the least care. In short, older people and those with mental health problems and long-term conditions will be at highest risk of losing out.

This will be further exacerbated by last year’s Darzi report, which promotes the creation of GP-led health centres and polyclinics. Despite being open all hours, these vast, anonymous places will only serve to drive care away from patients such as older people who – on the assumption they can get there – will be treated much further away from their homes by GPs they have no history or rapport with.

And, as money becomes tighter, what will be the effects on these polyclinics, the staff who work there, and the patients they treat? It won’t be an April fool’s trick when you call your glistening new health centre, report a stubbed toe and are asked, rote fashion, whether you feel you might
be unconscious.

Jane Warner is a practice nurse in Devon

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