The proposed division of primary care trusts’ provider and commissioner arms reminds me of the old legal concept of “one roof with separate rooms”.
It may not be totally appropriate to the NHS, but that legal notion was born out of the concept of a marriage breakdown, where a couple couldn’t afford two homes so they lived “apart” yet “together” in the same house. And let me say categorically that in East Lancashire that is not where we are starting from.
“A rushed job can be a botched job and that is in no-one’s interests”
The marriage of commissioning and provision is neither shotgun nor in a state of irretrievable breakdown, and although it may have its imperfect edges, we get along fine.
However, the government thinks it is in everyone’s interests, particularly those of the patient, to have a clear separation of the two functions and the two staffs and strategies. Although there is currently neither rancour nor ruction between our staff, we must get on with it and make it work.
But although dictating what must be done, the government has provided no single blueprint for all to follow. So a number of options are available and the views of patients and staff will help us decide on the best way forward.
Of course, some people will be champing at the bit for freedom and independence, but there must be a measured response at a realistic pace that ensures our priorities are delivered and that service continuity can be maintained. A rushed job can be a botched job and that is in no-one’s interests.
Few can disagree with the requirements of ensuring the safety of patients and services, as well as the issues of delivering care closer to home, developing more community based services and supporting existing acute services too.
A step-by-step approach would be the sensible option, with the nursing and service provision directorate travelling realistically down the road towards greater independence.
With no presumption of the outcome of our staff consultations, we could still be one PCT for the foreseeable future but with an arm’s-length relationship, working in an orderly and manageable fashion towards an ultimate solution that delivers services and creates sufficient distance between commissioning and provision.
All PCTs have a timetable to work to under the transforming community services agenda. As a minimum, the provider arm must have moved into a contractual relationship with the PCT by the beginning of the new financial year, starting this month in April 2009.
By next October, PCTs and practice based commissioners should have co-developed a detailed plan for transforming community services. No later than April 2010, the SHAs will have to clear the organisations’ fitness for purpose and then the plans can be implemented and rolled out that year.
Of course, it’s never simple. What about finance and HR directorates? Are they divided in two, or do you keep them together to maintain a critical mass of duties, functions and responsibilities that make them viable entities?
Much depends on which option is chosen as the way forward for the two organisations. So let’s work at it together and make the necessary changes over the agreed timescale and find a safe and sensible way forward.
We are travelling in the right direction, but we have to recognise the interests and rights of patients, and all staff, en route.