Clinicians Should Lead On Commissioning – BMA

Commissioning of NHS services must remain a core function of the NHS. Any attempt to privatise commissioning will put at risk the central ethos of the NHS, the British Medical Association (BMA) warns. Government plans to change how NHS services are commissioned will only succeed if there is proper clinical engagement in both primary and secondary care, and a meaningful dialogue with patients, the BMA says in its response to the Department of Health’s commissioning framework for England.

The BMA has produced its own set of principles that it would wish to see upheld as the role of commissioning develops:

• Promoting clinical engagement: clinicians should be involved in commissioning decisions to ensure services are planned on the basis of patients needs.
• Enabling cross-sector collaboration: clinical networks should be established across primary and secondary care, with a significant input from public health, to deliver patient-centred outcomes.
• Ensuring an appropriate balance between cost-effectiveness and quality: decisions must not be based solely on cost.
• Effective dialogue with patients and the public: there must be an open and honest debate with the public.
• Development of information systems: data upon which to base commissioning decisions must be accurate and timely.

Dr Laurence Buckman, deputy chairman of the BMA’s General Practitioners Committee said: “If we get commissioning right there is a real opportunity to improve the range and quality of health services available to patients. GP practices will want to work in collaboration with their consultant colleagues, and public health experts, to ensure that local health needs are properly assessed and the appropriate level of services commissioned.

“Practice-based commissioning is the primary tool intended for planning and purchasing local health services. However the policy is still in its infancy and will need to be further developed and appropriately resourced if it is to be successful.”

Dr Jonathan Fielden, chairman of the BMA’s consultants’ committee said: “The BMA supports, in principle, the introduction of a commissioning framework with uniform standards for inclusion in all contracts with providers of NHS activity. However there is a risk that commercial organisations, if also given a commissioning function, will commission work for themselves and benefit from the profits, putting at risk the overarching ethos and ethics of a publicly funded health service.

“NHS commissioning which is led by clinicians, working together across primary and secondary care, will ensure decisions on health services best meet the needs of patients. Doctors working in public health will have a particularly important role as they have an intimate knowledge of local and national health priorities.”