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Sir Nigel Crisp has announced a consultation process on expanding practice-based commissioning within the NHS, which may have profound implications for existing employees within the service.

http://www.dh.gov.uk/assetRoot/04/10/65/07/04106507.pdf

Extract from consultation document:

ROLES AND RESPONSIBILITIES IN COMMISSIONING

Practice Based Commissioning

1. The Government is committed to Practice Based Commissioning as a way of devolving power to local doctors and nurses to improve patient care. It is also a way of aligning local clinical and financial responsibilities.

2. Under Practice Based Commissioning, GP practices will take on responsibility from their PCTs for commissioning services that meet the health needs of their local population. Commissioning practices, or groups of practices will have the following main functions:

• designing improved patient pathways;
• working in partnership with PCTs to create community based services that are more convenient for patients;
• responsibility for a budget delegated from the PCT, which covers acute, community and emergency care;
• managing the budget effectively.

3. Under Practice Based Commissioning GPs will not be responsible for placing or managing contracts. That will be done by PCTs on behalf of practice groups, with back office functions including payment administered by regional/national hubs. GP Practices will also receive management support, the size of which will be dependent of the numbers of practices involved. Further details on these arrangements will be set out in October following discussion with relevant stakeholders.

4. There is a strong desire in general practice to make rapid progress in rolling out Practice Based Commissioning more rapidly. In line with this desire, and given the strategic importance of commissioning to the system reform agenda, the Department can confirm that it expects to see PCTs make arrangements for 100% coverage of Practice Based Commissioning by no later than the end of 2006. Individual practices will have the option to take on commissioning to a greater or lesser extent depending on their wishes and their capabilities.


Comments?

Strategic planning = positioning oneself now to be in the best position to take advantage of this in case its implemented. The creative and innovative will thrive as they position themselves well.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

No doubt about it Craig. What is of concern is the effect that such radical changes in funding and commissioning public care - including podiatry - has on existing NHS employees. There looms the possibility of changes to employment status and all the inherent implications for pension and redundancy rights. It will be the responsibility of GP practices to determine and purchase the level of care they consider necessary and there is no guarantee they will have to use existing NHS services - indeed there is active encouragement to engage other service providers - including the private sector. These proposals will drastically alter the way foot health services are structured and it could be that by 2007 core NHS employment levels will be a fraction of what they are today, with the majority in general practice incorporated into and employed or contracted with medical practices, not PCTs.

I agree there are obvious opportunities for the profession - I am not averse to podiatry being structured in this way, with a core employed specialist workforce complimented and supported by a devolved general practice network. Such a practice structure makes absolute sense. But there are dangers too. I would have preferred a commissioning body to be independent and not have GP practices having the responsibility for our budgets. Nor is there any mention of an inspectorate - and it is plainly ludicrous to expect the HPC to monitor NHS contractual standards within its existing remit.

Not to mention all the personnel issues and the fiinancial implications for clinicians in the public and private sectors. The transitional arrangements should be fun.

Interesting times indeed.

Mark

Did I hear you mention the Danes recently?

http://news.bbc.co.uk/sport1/hi/foot...ls/4154680.stm

I'm sorry - this is totaly irrelevant and inappropriate, but is his name really Sir Nigel Crisp? It sounds disturbingly like something out of a BBC comedy. Sorry - serious business I know, but it has put a smile on my face......

I'm afraid so and absolutely no relation to dear old Peregrine Bagshot.