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“We’ve got very confused about what commissioning is in England. If you look at what’s happening to the payer function in other countries it’s getting much larger and it’s much more interested in strategy. In general it’s not doing what we’ve done in England, which is to interfere with the detailed running of providers.
When commissioning was developed it was essentially another way of doing top-down management but while pretending to do contracting. So when we hand this over to GPs there’s some thinking to do here because GPs largely are providers. The things that GP commissioners talk about are about the design and provision. They’re not about doing a classic payer function.
So “perhaps we really need to think about whether we want to a payer provider split and if we do we’d be much better off asking the GPs to take responsibility for the design of the local provider system and how to work better with their colleagues in hospitals and in social care where there’s a big win that I feel the government has neglected... rather than trying to ask them to replicate the broken model of commissioning. And after twenty years it might be time to say we need a new approach.”
There’s there’s a big potential in GP commissioning but it will require us to rethink commissioning, So I’m very keen on seeing clinicians and GPs in particular getting involved in redesigning their local systems, but calling it commissioning is perhaps a bit unhelpful.
The big unanswered question in all of that is ‘Who looks after the sort of strategic oversight?
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