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Thursday 24th May 2018

The commissioning conspiracy

24th November 2006

Dr Andy Jones, GP and practice based commissioning director at UnitedHealth Europe wonders if a PCT conspiracy is behind the failure of clinical commissioning to take off.

‘Commissioning is the buzzword in health systems across the western world,’ he writes in the Health Service Journal.

But is it delivering on the high expectations that it was greeted with by both public service supporters and market economists when it was first launched two years ago? The easy answer is nowhere near.

‘The policy model remains sound but clearly the implementation has been less than spectacular,’ he writes.

The problem could be a lack of real commitment to the idea, being happy to talk about commissioning is not the same as really engaging in it. And the NHS clearly has a very long way to go before even a small percentage of health spending comes as a result of real commissioning.

So what is the problem? Jones has plenty of ideas, but lack of incentives isn’t one of them. The system clearly offers up its own incentives, by freeing up funds for reinvestment.

Instead it is explained by lack enthusiasm and interest – too many saw it as an add-on to management so it dropped below the radar of too many PCTs which has left most woefully behind when it comes to doing the legwork, like collecting meaningful activity data, necessary before the real work could begin. ‘It fell well below the notions of tidying up the office, filing a mileage claim and renewing the annual insurance for the dog.’

Dismissing the conspiracy theory, he argues for the need to break down the ‘cost for diseases across a disease level’ before commissioners can take a wide enough view of what represents good value across the NHS.

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