The end of the beginning?6th December 2006
Now that the SHAs and PCTs have been rationalised, you may think life will settle down, says Mike Sobanja. And you would be "wrong, wrong, wrong."
Firstly, the reassurances of an end to restructuring are "simply not true"; there are already plans afoot for the joint management of PCTs and it is doubtful the 31 PCTs in London will survive beyond next year. The recent reconfiguration was designed to create co-terminosity with local authority boundaries but it is likely that local authorities themselves will be restructured after next year's local elections. Secondly, practice based commissioning, which is neither practiced-based nor solely commissioning, will take time to bed down as PCTs and these new groups learn to live with each other. â€œSpot the commissionerâ€? is a game to be played for some time yet. Thirdly, how will specialised commissioners - who also need to be rejigged - fit into the new system of SHAs, PCTs and PBCs? And as for clinical networks; only time will tell how they fit into this transformed landscape. Why all the change? Because the government needs to address commissioning and this time get it right. But the provider side also requires change and emerging Foundation Trusts are just one part of that. In our new "immature" market, the most urgent thing will be to sort out Payment by Results and a "real IT systemâ€?. Then there is just the issue of regulation - how to join up the current myriad bodies and regulatory tools such as NICE, CHI and QOF. A little way to go? I think so, concludes Mike Sobanja â€“ itâ€™s probably "the end of the beginning, rather than the beginning of the end".
Mike Sobanja is NHS Alliance Chief Executive and Non Executive Director of Health Direction.
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