NHS London has awarded a contract to the KPMG Partnership for Commissioning to support the development of pathfinders across the capital. The partnership, claimed to be the first of its kind, sees KPMG teaming up with UnitedHealth UK, the National Association of Primary Care, Healthskills, NHS Primary Care Commissioning and legal firm Morgan Cole.NHS London is the strategic health authority (SHA) for London, as the name suggests it provides the strategic policy for the area. NHS London oversees the commissioning performed by eleven primary care trusts (PCTs), these PCTs commission care from GPs, community health services, acute and mental health trust (hospitals). The "pathfinders" are groups of GP practices (consortia) who, under Andrew Lansley's plans, will take over commissioning from PCTs in the next couple of years. The "pathfinder" status is not a pilot or trial because GP commissioning will happen even if the pathfinders fail. The pathfinder programme is just a way for Lansley to implement his policy without Parliamentary approval; undemocratic, sure, but then again, we have a Conservative government without an electoral mandate.
There are several interesting things about this decision. The first is that there will be one, SHA-wide, organisation providing commissioning, whereas under PCTs there were eleven such commissioning organisations. Can someone tell me how this decision will provide the much lauded "localism" that this government strives for? This seems to me to be taking the commissioning decisions away from the local level and into a large, private organisation.
Admittedly, this decision is just for the interim, the pathfinders are not yet statutory organisations and are in "shadow" form so when they have complete control they will be able to buy services from whoever they choose. However, it is likely that a pathfinder consortium which takes on the services of this company would find it expensive to change provider or to provide the services themselves later on, so this this company will be the provider in the future.
Reading through the comments on the Pulse article raises other questions:
- Anonymous - London | 14 Jan 11 I don't wish to be churlish but, under competition law NHS London are obliged to run a open tender for this contract. I have seen no advertised tender, and suspect there was none - which just isn't right. I doubt if anyone will refer the matter to the competition authorities, however...
Another point is that the commissioning (for the interim at least) is being handed over to one private company. We know that PCTs currently employ commissioners and it has been suggested many times that PCT commissioners would transfer to the new consortia. This has not been the case in London. The commissioning has been handed over entirely to a private company. Of course, that company is likely to recruit existing, experienced commissioners, but this is not the situation that was spread in the Press by Conservatives (in an attempt to allay fears of privatisation). This was picked up by one of the comment writers on the Pulse pice:
- Marie-Louise Irvine - London | 14 Jan 11 This is just the beginning. Now they are the ones providing commissioning support for pathfinder consortia - next they will be providing the commissioning support for actual consortia after 2013. For those who think that consortia will be able to employ ex PCT people directly - I have news for you. At an information event about consortia development I attended the other day we were informed that consortia will very likely have to tender for their commissioning support. Ex PCT people will have to form organisations and competitively bid for the contracts. Organizations like KPMG will be light years ahead of them in knowing how to win these contracts. Some GPs have a kind of fantasy consortium idea in their heads, where they will be able to carry on the kind of co-operative and collaborative relationships they value such as with the local hospital, experienced local ex PCT staff, etc, whereas the harsh truth is that they will be so circumscribed by competition law and and outsmarted by clever and powerful private companies, that they will find they can't do many of the things they'd like to. There will be little room for manoeuvre. But as long as the GPs make the cuts and take the flak they will be serving their purpose. I can predict one thing - it won't feel like "empowerment".
If this is an indication of what the future holds, it certainly shows that the publicly owned NHS is on its way out.