Who then should commission?
GP generally do not have the time, skills or inclination to get deeply involved in the process of commissioning. The greater involvement of GPs in the health care planning process is to be welcomed, but for the reasons above it is neither likely nor desirable that GPs should be doing it all. Neither is it acceptable that private, for profit corporate companies or Consultancies should take over the commissioning function. The potential for conflict of interest and the lack of public accountability would make this unacceptable.
The body that does the commissioning should remain a public body.
The ideal solution would have been that PCTs, preferably slimmed down and with many functions removed, should continue the commissioning function subject to the oversight and input of a professional executive committee. It may be too late for such a solution to be based on the full complement of current PCTs, though many feel that the PCT clusters would be ideally placed to fulfil this role.
There remain concerns that commissioning may be subcontracted to private companies or consultancies. Ministers have sought to offer reassurance that this would not be permitted but unfortunately the use of the ambiguous word ‘responsible’ as in “CCGs as public bodies will remain responsible for commissioning decisions” has fed anxieties rather than giving reassurance. It is theoretically possible under such arrangements for the CCG to exert a purely nominal function, meeting from time to time to rubber stamp actions and decisions taken by a subcontractor that meets in private and is not open and accountable in the way that is the norm for public bodies.
- The commissioning function should remain explicitly a public function carried out by a public body.