In recent months there has been growing interest in proposals to devolve 'hard' commissioning budgets to GP practices, or to groups of practices working together in integrated care organisations, community health collaboratives or clinical partnerships. This joint NHS Confederation and National Association of Primary Care workshop in London, allowed senior GPs, commissioners, policy analysts and civil servants to come together and consider how a policy of hard commissioning budgets might work in practice.
There was general agreement among participants with the central idea that if primary care professionals had both more control over commissioning decisions and more accountability for the outcome of those decisions, improvements to both quality and efficiency could be delivered. Nevertheless, as the discussion focussed in on specific details of how such a policy would be implemented, both the complexity of the issue and the wide range of views on this topic became apparent.
Conclusions and looking forward
By the end of the workshop it was clear that finding a way to effectively balance incentives, autonomy and accountability would be key to making this policy work. Incentives must be sufficient enough to ensure that primary care clinicians are motivated to participate and enabled to do things differently. However, patients and taxpayers must also be assured that modern, safe, high quality, cost effective healthcare will be consistently available across the country.
Our workshop helped to crystallise some of policy dilemmas that will need to be resolved if this balance is to be achieved, and to identify potential solutions.
We aim to explore these issues in more detail over the next few months. If you would like to participate in this debate, please contact Elizabeth Wade Elizabeth.wade@nhsconfed.org