{"id":7706,"date":"2011-03-17T14:45:30","date_gmt":"2011-03-17T13:45:30","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=7706"},"modified":"2011-03-17T15:31:38","modified_gmt":"2011-03-17T14:31:38","slug":"douglas-noble-on-gp-commissioning","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2011\/03\/17\/douglas-noble-on-gp-commissioning\/","title":{"rendered":"Douglas Noble on GP commissioning"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" style=\"float: left\" src=\"http:\/\/www.bmj.com\/columns\/icons\/douglas_noble.jpg\" alt=\"douglas noble\" width=\"160\" height=\"110\" \/>A few weeks ago I attended a conference for GPs on commissioning in the brave new world of GP consortia, proposed in the <a href=\"http:\/\/www.dh.gov.uk\/en\/Publicationsandstatistics\/Legislation\/Actsandbills\/HealthandSocialCareBill2011\/index.htm\">recent health bill<\/a>.\u00a0<\/p>\n<p>The day started with a very upbeat GP seeking to enthuse the audience of about 70 participants with a reverberating war cry: &#8220;commissioning! who\u2019s up for it?&#8221;\u00a0One hand shot up like Hermione\u2019s from Harry Potter. A few awkward seconds passed and slowly another hand went up with a turn of the head hoping they weren\u2019t alone. They were. Two out of 70. What a start!\u00a0<!--more--><\/p>\n<p>Various highlights from the day stand out. At one point delegates were split into groups to simulate a commissioning encounter between GP Consortia and Acute Trusts.\u00a0Amongst other things the scenario involved delivering services for lower cost.\u00a0With lightening speed our group determined their approach: &#8220;What shall we cut?&#8221; Someone interjected gently: &#8220;What about improving quality in the existing processes of care and reducing costs that way?&#8221; &#8220;Ooo good idea, we\u2019ll try that too,&#8221; was the excited response.\u00a0<\/p>\n<p>In the run up to the day there was a last minute change resulting in the workshop on data being dropped. Horrors. Data-free commissioning. Thankfully the email indicated the &#8220;data-bit&#8221; would be incorporated within another session. I trundled along to this at the end of the day and enjoyed a very competent presentation on the process of commissioning. Two slides went up on data.\u00a0One on all the different types in the NHS, the other on the vast number of resources to assist with using and understanding it, including the <a href=\"http:\/\/www.ic.nhs.uk\/\">NHS information Centre<\/a> and <a href=\"https:\/\/www.nhscomparators.nhs.uk\/\">NHS Comparators<\/a>\u00a0websites. Things were looking up. Then came the next poll: &#8220;Who here has ever heard of or used any of these resources?&#8221; No hands. Zero out of 35. For a self-selected population of GPs who wanted to come to a commissioning conference this was now starting to get really worrying.\u00a0<\/p>\n<p>And that is maybe the bottom line; there is something disturbing about all this sudden change. In essence we are asking a group of doctors with minimal skills in handling service and population level data, negotiating contracts, monitoring performance, and determining health policy, to overnight perform these tasks for large geographical sectors as if they were second nature. It\u2019s not <a href=\"http:\/\/healthandcare.dh.gov.uk\/category\/context\/pathfinder-learning-network\/\">a pathfinder<\/a> they\u2019ll need; it\u2019s a solar flare.\u00a0<\/p>\n<p>Yet, it doesn\u2019t need to be this way. GPs were heavily involved in PCTs on CECs and PECs and numerous other inelegant acronyms. What we need is a repositioning of GPs to be the leading decision-makers ahead of NHS bureaucrats, not a complete restructuring.\u00a0With this more nuanced approach GP leaders could remove wasteful activities within PCTs, keep the best people with the skills they don\u2019t have, and build joint pathways of care with local hospitals.\u00a0<\/p>\n<p>Finally, GPs need to resist the mistake the previous government made by bringing in private consultants at every turn. Instead, for ensuring evidence and population health needs are at the forefront of commissioning, GPs and Public Health doctors need to work together like never before.\u00a0By sharing their extensive knowledge of patients, populations and quality and safety in healthcare, world class commissioning might even be realised.<\/p>\n<p><em><strong>Douglas Noble <\/strong>has worked in surgery, emergency medicine, public health and for WHO. From 2006 to 2008 he was clinical adviser to the chief medical officer for England.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A few weeks ago I attended a conference for GPs on commissioning in the brave new world of GP consortia, proposed in the recent health bill.\u00a0 The day started with [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2011\/03\/17\/douglas-noble-on-gp-commissioning\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1576],"tags":[1916,2033],"class_list":["post-7706","post","type-post","status-publish","format-standard","hentry","category-douglas-noble","tag-gp-commissioning","tag-gp-consortia"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Douglas Noble on GP commissioning - 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