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Lord Howe: 'GP Commissioning: Making It Happen'

  • Last modified date:
    13 September 2010
Lord Howe

Lord Howe, Parliamentary Under Secretary of State for Quality, spoke at the King’s Fund, 7 September 2010

(Checked against delivery)

Last month my thoughts turned to one of the great moments in our country’s history.  The Battle of Britain was critical in altering events of the war and saving the lives and liberty of millions.

In that same decade came an equally similar, if less immediately dramatic event. 

The coalition government of the time - it is surprising, isn’t it, just how radical coalitions can be - produced the Beveridge Report, which undertook to fight against the Five Giants of Want, Disease, Ignorance, Squalor and Idleness.  And on 5 July 1948, the National Health Service, the embodiment of that fight, burst upon the national landscape and quickly become our nation’s most treasured institution.  The doctors and nurses of the NHS may significantly outnumber ‘The Few’ who fought in the Battle of Britain, but their work has easily saved as many lives and has transformed those of countless others. 

I am deeply proud of our National Health Service.  I am proud of its values - of healthcare based upon the need of the patient rather than their ability to pay.  And I am deeply proud of the people who make it work, day and night, week in and week out.  Not only the doctors and nurses who for obvious reasons tend to get the credit.  But also the cleaners, the healthcare assistants, the porters, the physios, the occupational therapists.  And let us not forget the managers, who tend to get a rather unkind press at times, but not from my direction.  All are dedicated to improving the health of our nation and all will be vital as we improve the NHS in the years to come.

And improve it must.  For although it has transformed life in Britain, although it saves lives on a daily basis and although we gladly look to it for guidance on how to live a healthy life, we all know all of us can do so much better. 

The last decade saw massive investment in the NHS.  Funding has now risen to more-or-less the European average.  Yet, while this has brought much needed new hospitals and equipment and many new doctors and nurses, it has not significantly improved what is most important of all, health outcomes. 

Despite everything that the previous government did, and it did a great deal, survival rates for cervical, colo-rectal and breast cancer are among the worst in the OECD.  We are on the wrong side of the average for premature mortality from lung cancer, and heart and respiratory disease.  And you’re more than twice as likely to die from a heart attack here in the UK than you are in France. 

Patients deserve better.  The NHS can be better.  And with the reforms we have set out in the White Paper, it will be better. 

There are many aspects of the White Paper that we could discuss today:  how we will give more power to patients to shape their own care; how we will inject local democratic accountability into the system; our clear focus on improving health outcomes rather than a maddening emphasis on process targets; or our plans to check the demand for healthcare through much better public health.

But today is about commissioning and how we make it work better for patients.  So I think we should first pause to define exactly what we mean by that. 

Traditionally, governments of all colours have made the mistake of thinking that the best way to deliver healthcare was through some degree of central diktat.  That Ministers in Westminster and officials in Whitehall, by definition, knew best.  Speaking from personal experience, I know that this is not so.

GP commissioning is a new approach to the design and delivery of healthcare.  It’s about understanding the needs of a local population, of groups and of individual patients.  It’s about working with patients and the full range of health professionals to agree and design the services that best meet those needs.  It’s about creating a clinical blueprint that forms the basis for contracts with providers.  And it’s about holding a range of contracts to offer choice for patients wherever possible and monitoring those contracts to make sure that services are delivered to the right standards of quality. 

Our proposals for GP commissioning will push decision making much closer to patients and local communities and ensure that commissioners are accountable to them.  It is the GPs on the ground who are best placed to lead.  For it is GPs who see patients with every conceivable ailment on a daily basis.  It is GPs who navigate the system every day on behalf of their patients.  And so it is GPs who we will empower to lead and transform the system in conjunction with their professional colleagues across primary, secondary and community care.  They will work closely with other professionals to design joined up services that make sense to patients and the public.

This government believes that power is something to be given away, not hoarded.  Local services should be accountable to local people.  Working in partnership with local authorities, with the local HealthWatch, with the whole gambit of professions across the local health economy, GPs will be able to design better, more responsive and more accountable services.

At the moment it is the job of the Primary Care Trust to commission services for their community, and some PCTs carry out this function with great skill and efficiency – I visited one last week.  But, to be frank, overall the quality of commissioning has been poor and inconsistent.

By 2013, the power to commission most NHS services will shift from PCTs to consortia of GP practices, supported by the NHS Commissioning Board.  Of course, the real challenge will be moving from one system to the other.

During this time, PCTs will have a crucial role to play in supporting GPs.  Sharing best practice and helping them understand some of the challenges that commissioning services will bring.

But supporting GPs is not the same as leading them by the nose.  It is for GP practices to come together and form consortia.  And it is for consortia to decide how they will organise themselves.  PCTs will be invaluable to this process, but I think it is essential that the process is lead by general practice, not by Primary Care Trusts.

At the same time, this is not about practices being on their own.  Effective GP commissioning will only come about when there is the full range of professional input.  Now GPs clearly have clinical expertise, they also have the power of referral, and they are very trusted individuals.  But I hope that all GPs would agree that to design and deliver complex services that meet the needs of local people requires an effective partnership with other health care professionals, including nurses, allied health professionals and hospital doctors.  They all have a role to play.

Now, we’re not going to tell consortia how to organise themselves.  Some may take commissioning decisions collectively.  For instance, adopting a lead commissioner role could be a good route for contracting with a very large hospital trust and urgent care provider.  But other consortia may decide to do things differently. 

Consortia will decide what commissioning activities they undertake themselves and which they choose to buy in from outside.  Local authorities, private or voluntary sector bodies are all in a position to help them commission effectively.  We do not favour one sector over another, that decision is one for consortia.  Rather we favour a truly level playing field where the only determinant of who provides a service is the quality of that service.  We will do all we can to ensure that conflicts of interest never interfere with the delivery of high quality healthcare.

There is no set model.  Consortia are going to evolve and grow organically in the interests of their patients.

So when we get down into the minutiae of organisational structures, oversight mechanisms and financial management, let us always keep in mind the reason we are reforming health in this way.  It boils down to trust – this government trusts the men and women of the Health Service.  And we believe that by trusting them, by trusting you to organise healthcare, we will see markedly better outcomes for patients.

I hope that this is the moment when GPs, and their colleagues throughout the Health Service, have all been waiting for.  What our proposals amount to is the bringing together of clinical decision making with the power to decide how money is spent.  I think that putting those two things together provides an extremely exciting prospect for Health Service.

Many doctors I’ve spoken to have, in one way or another, described their frustration at how the system sometimes gets in their way.  They want to act in the best interests of their patients but for whatever reason they can’t.  I hope that the new system of GP commissioning will change this.  I hope that the end result is not only more cost effective care, but also better care.  That’s what all this is about - raising our game as a health service.

For over 60 years, the Health Service has been valiantly taking on Beveridge’s giant of disease.  It has overcome considerable odds to improve our nation’s health beyond recognition and will continue to do so in the decades to come.  Yet from now on, it will not be Ministers like me in charge.  It will be patients and it will be you, the professionals, who are calling the shots.

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