Clinical engagement needs more teeth, says Farrar

The NHS should explore 'radical models of clinical engagement' to give clinicians 'more teeth' and to improve scrutiny of potential conflicts of interests, the new chief executive of North East strategic health authority has said.

Mike Farrar, architect of the GP contract and former Department of Health head of primary care, said some gains in clinical engagement under the primary care group model had been lost with the creation of primary care trusts.

'When you look back, PCGs had a lot of strength in clinical engagement ... we have gone backwards a bit from that. I think PCTs' 'three at the top' [the power-sharing arrangements between chief executive, chair and professional executive committee chair] has not been universally successful and the time is right to think about more radical models of clinical engagement.'

He suggested a model mirroring local government overview and scrutiny committees, which would not requite legislation. 'In local government the cabinet makes the decision but the OSCs have the right to check the way it's made.

'You could think about the professional executive committee having a scrutiny role based on asking if there has been sufficient clinical engagement etc... not a right of veto, but it might give them more teeth.'

Mr Farrar said clear separation of roles might also help address potential conflicts of interests for GPs: 'When we come to practice-based commissioning and some of the decisions that might be taken, there's a risk of getting into conflicts of interests when you've got a PEC of leading GPs who might also be involved in professional committees.'

He also floated previous ideas to incentivise providers to compete on quality, by giving them 'quality premiums', in particular in rural areas with fewer competing providers.

'How would we use the facility of competing providers which might be driving down some costs while acknowledging that in some parts of the patch you might want to potentially subsidise healthcare, but in that subsidy make rural providers contractually obliged to give a return on quality.'