The government must formally acknowledge the vital role consultants can play in commissioning, the Royal College of Physicians has said in its white paper response.

In its formal response to the Liberating the NHS document, the RCP said it supported the emphasis on commissioning of health services by clinicians in collaboration with managers, but said “there is little mention of the role that specialist physicians could play in commissioning”.

Commissioning should always be clinically led and based on more effective dialogue and partnership between GPs and hospital specialists.

The response says: “Without engagement with specialists, commissioning could further separate primary and secondary care and make service transformation difficult.”

It also warns:  “GPs and consultants can become opponents in a bidding war, rather than working cooperatively as colleagues with different areas of complementary competence.

“To mitigate these risks we propose that consortia are explicitly required to include specialist clinical and public health advice on commissioning services and that clear commissioning guidance is developed with professional input,” the college said.

For example, it said specialists and public health doctors should hold permanent posts within the governance structure of consortia.

A spokesman for the college said it would be lobbying the government over the involvement of secondary care doctors in the new GP led commissioning system that is due to replace primary care trusts.

He said: “We want a formal acknowledgement that specialist doctors can play a really useful role within the commissioning process. This is especially the case if the aim is to deliver seamless care that matches the right setting and team to the patient’s needs.

“Under the current proposals, GPs may contact their specialist colleagues but many hospital based physicians have genuine anxieties about being locked out of the conversation.”

He also added that the college was “very concerned that the rush to ‘outcomes’ measurement”, ignored the fact that lots of process targets have great clinical value, and in the absence of real outcome measures are useful proxies for measurement.

“We also have reservations about the quality of the data the government proposes to use during the early stages,” he said.

Additionally, he added the decision to make all providers foundation trusts within a short time carries risks to patient care, for example Mid Staffordshire.

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