BMA attacks commissioning support plans

The British Medical Association has attacked Department of Health’s plans for providing support to clinical commissioning groups for opening the door to the private sector.

The BMA argues that guidance from the DH on providing technical, ‘back office’ and commissioning support to CCGs will make it almost impossible for NHS bodies to compete with established, commercial rivals.

The draft guidance, ‘Developing commissioning support: Towards service excellence’ – which was leaked to the Health Service Journal a few weeks ago – says CCGs will have the “freedom” to decide how to carry out their commissioning functions.

However, it also stresses that they must be “better and more efficient than anything that has gone before”, which will mean “doing things differently”.

It notes that, at the moment, primary care trust clusters are “working to develop sustainable models of commissioning support”, either by hosting new organisations or by setting up joint-ventures with local authorities, the private and voluntary sectors.

However, after a transitional period in which the NHS Commissioning Board will also host some support functions, it indicates that it expects CCGs to keep commissioning support units at arm’s-length, by setting them up as social enterprises or private sector joint ventures.

The BMA is concerned that that the DH’s guidance will “make it very difficult for CCGs to employ their own commissioning support staff” or for emerging NHS commissioning support bodies to go on to compete with “large, established commercial organisations.”

As a result, it warns that CCGs will be pushed into using private players everything from “transactional services such as payroll and IT services, to equipping CCGs with the complex and sensitive population data that inform commissioning decisions.”

This, it adds, would give the private sector undue clout, and so “undermine the government’s proposals for genuine, clinician-led and locally focussed commissioning.”

Dr Laurence Buckman, chair of the BMA’s GP committee, said: “The latest guidance gives the commercial sector an in-built advantage, and appears to be yet another worrying step towards an NHS focused on commercial priorities.”

He said PCT clusters should, instead, be supported “to become viable commissioning support organisations” and that the BMA would be meeting the government to “urge it to reconsider these proposals.”

As EHI reported last month, the draft guidance suggests that IT support and the provision of business intelligence services are among the services that the DH expects to be provided by shared organisations working with a number of CCGs.

The guidance also says that IT and BI are services for which CCGs could contract with “a wide range of NHS and commercial organisations” – suggesting that the DH expects many to move into the private sector.

EHI Primary Care's exclusive survey of CCG IT and information plans suggests many will be happy with this - since around half of its respondents said they would be looking outside the NHS for at least some elements of IT and information support.

However, emerging CCGs with well-established informatics services have expressed concern about the government's direction of travel, arguing that locally developed and focused systems are essential for effective responses to local needs.