Making clinical commissioning work

When the talking is over, the action can begin. The Government’s reforms have faced an uphill struggle since June 2010 and the launch of the White Paper. With the consultation phase, the NHS Future Forum and now further amendments likely to be put forward by the House of Lords, the eventual reforms will look very different to the original proposals. However the core idea of clinically led local commissioning remains intact. Whatever the merits of the proposals, the time for debating the principles of the reforms has passed; the challenge is now to make clinical commissioning work.

Implementing the Health and Social Care Bill could prove more demanding than getting the Bill through Parliament. For a start the deadlines are tight: in 18 months from now SHAs and PCTs will be abolished and the NHS Commissioning Board will take on its full functions. A full system of Clinical Commissioning Groups will be established, with the Commissioning Board authorising groups to assume their responsibilities when they have met set conditions.

The good news is that real progress is being made. As of July 2011 257 Clinical Commissioning Groups have been formed covering 97 per cent of the population. Some entrepreneurial and innovative clinical commissioners and GP leaders have emerged. The Commissioning Board has been established in Shadow form, SHA and PCT clusters are being set up, local authority Wellbeing Boards and HealthWatch are coming together. However the pillars of the new system and nascent commissioners still have a long way to go.

NHS leaders and policy makers now need to focus on getting the most from the Government’s reforms. The Commissioning Board will need to allow more flexibility for commissioning groups to capture the potential of clinical leadership and local innovation. As well as retaining the best management and leadership skills, the NHS needs to improve commissioning and the financial skills of clinicians. Commissioners will need to be bold in fostering greater competition between providers and making healthcare responsive to patients. New entrants will be needed to develop working partnerships between primary, secondary and social care. All the time clinical commissioners will need to help deliver the £20 billion “Nicholson Challenge” and maintain and improve the quality of care.

Clinical commissioners will face many hurdles but now is the time to learn from the best. There is valuable commissioning expertise, both within the system and outside of it, that cannot be lost. Some pathfinder groups are already showing what clinical commissioning can achieve. This event will showcase, celebrate and help spread best practice at a time when the NHS needs a step change in the pace of change.

When the Health Bill is passed into law it will mark the “end of the beginning” for the NHS this Parliament. The challenge is clear: make clinical commissioning work and deliver value for money in ways that lead to better healthcare.