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Liberating the NHS: commission impossible?

Lynn Young
Primary Healthcare Adviser for the RCN

In this issue, Lynn Young discusses the proposals set out by the new coalition government on the future of the NHS. But as part of the nursing profession in general practice, will you be keen to get involved? 

Many of you will remember that splendid community nursing document published by the Department of Health in 2004, entitled Liberating the Talents. Sadly, the recommendations made in this document failed to be implemented across the country, which many senior community nurses regret, in the belief that the framework offered a bold way ahead for community nursing services.

However, we are where we are, and now that the coalition government has declared its intentions for the NHS in England in the shape of the new White Paper, Liberating the NHS, the nursing profession has to rapidly grasp the implications of the changes that lie ahead. I just wonder if one of the authors of the paper also contributed to the nursing document of 2004. Clearly the way ahead leads to utter freedom and liberation within the healthcare world?!

But back to the White Paper, which has caused significant media activity and a wide range of views from various journalists. In summary, the commissioning cash is to be transferred from the primary care trusts (PCTs) into the hands of new GP consortia. We need to ensure that the proposed consortia include nurses and other experienced NHS commissioners. GPs cannot successfully commission healthcare services on their own; and if they do not yet realise this, will need to be gently persuaded that this is so.

Many of us wise elders remember the days of GP fundholding, multi-funds and total purchasing sites. Some of them managed to improve certain services for their patients and used public funds to expand general practice-based care. At the same time, other fundholding practices achieved little in the way of improvement for their patients.

Twenty years later, a coalition government intends to implement a system that gives a large proportion of commissioning cash to general practices, not just the 20% given to the fund-holders operating during the 1990s. The world has moved on and we must adapt to working at a time in which savings have to be made, while recognising that there is a profound need to improve public health and community health services.

The healthcare revolution is not going to happen tomorrow, next month, or even next year. There is a huge amount of preparation required to ensure that the new system is fit for purpose. Lansley has declared that PCTs will not be abolished until 2013, and that NHS management costs must be reduced by 45% by the end of 2014. One can only imagine the number of DH papers that will be produced during the next 12 months describing how the new system and structures are to be implemented.

The one constant within the NHS is general practice, which, although tweaked and often challenged by various politicians, continues to be fundamentally the same as it was in 1948. The fact that 98% of the population is registered with a surgery adds huge strength and stability to this essential part of the NHS. There are many sound reasons for focusing commissioning around general practices, but the truth is that the process cannot successfully be run by GPs alone. GPs will need all the help they can get from their nursing colleagues, patients and skilled NHS commissioning managers.

While the Lansley Way means upheaval and colossal reconstruction, we could well see a similar landscape to previous times of NHS reform: the same people simply moving along to different places but with the same responsibilities.

Nurses, wherever they work, need to keep well informed about what is happening to developing commissioning arrangements in their area. Many, on account of their experience, skills and knowledge, and with absolute justification, will be incredibly keen to get involved. The most successful GP consortia will have among its ranks a splendid spread of energetic, expert and enthused commissioning nurses.