Hospital doctors and commissioning

One of the complaints about GP commissioning was that it lacked the collaboration with secondary care doctors in hospitals. One solution was to put a hospital doctor on the commissioning boards. However, Andrew Lansley, quite rightly, objected to this. Commissioning groups are purchasers of healthcare, hospitals are providers and putting a hospital doctor on a commissioning board means that a provider could be involved in purchasing healthcare from themselves: a conflict of interest.

However, the government has now accepted this idea as long as the doctor is not from a local provider. So how can this work in practice: is it possible for doctors from the other end of the country to sit on a commissioning board? Pulse reports on Lansley's new plan:

Mr Lansley said it was imperative that conflicts of interest were avoided, but said the problem could resolved by appointing specialists doing tertiary work, hospital doctors who had recently retired, or consultants who lived in the local area but worked elsewhere.

Patient choice means that patients can go to any hospital and the limit is usually the distance that the patient will travel. One would assume that patients are willing to travel further for treatment than a consultant would travel to get to work, so the third criteria "consultants who lived in the local area but worked elsewhere" would present some conflicts of interest. Tertiary care is commissioned by the new super-quango, the National Commissioning Board, so there will be no conflicts of interest. It seems that the new hospital doctors on commissioning boards will be either tertiary or retired consultants.

Wouldn't it be simpler just to change to a collaborative model? This would get rid of any concept of conflicts of interest since local GPs will commission the local hospital and so local hospital doctors can work with them to design services.