The Liberal Democrats want GP services to be commissioned by health and wellbeing boards, according to a paper setting out the party’s likely policy direction in the run up to next year’s general election.

Protecting Public Services and Making Them Work for You signals the party’s favoured approach across a range of public services including health, education and transport, and has been published in advance of its annual autumn conference.

According to the paper, some HWBs should be able to expand their role during the next parliament.

“Where [they] are able to demonstrate robust and democratically accountable governance, we would like to see them taking over NHS England’s responsible for commissioning GPs in their area, and potentially wider responsibility for local services,” the paper said.

“Some are already developing along these lines.

“It makes no sense, and is a major centralisation from the previous [primary care trust] arrangements for commissioning of thousands of local GPs to be carried out by one national body which has no democratic accountability.

“It will be much better for patients, residents and local services for this to be done locally.”

The proposed policy suggests GP commissioning could be localised while avoiding potential conflicts of interest which could come with devolving the responsibility to clinical commissioning groups.

Under the paper’s proposed approach, HWBs rather than Whitehall would be expected to suggest how to make local commissioning work.

While the paper suggested that this could involve the boards taking on “direct commissioning responsibility”, it does not set out how this could be achieved.

As HWBs cannot currently hold a budget, new legislation would be required for them to take on a direct commissioning role.

HWBs should also commission child and adolescent mental health services “as part of the better care fund”, the paper recommended.

It also said the amount of money channelled through the better care fund should increase.

Chaand Nagpaul, chair of the British Medical Association’s GP committee, told HSJ he believed GP contracting should remain centralised, and that “it wouldn’t make sense to create a local bureaucracy to manage a national contract”.

“It’s much more important to explore ways of working together… There are already flexibilities to have pooled commissioning budgets – we have not made enough use of pooling resources where relevant. That should be the focus,” he said.

The paper will be considered by the party’s conference, which is due to be held in Glasgow next month.

The Better Outcome Board

The Liberal Democrat paper on public services also introduces a proposal for a new form of local collaboration – the “better outcome board”. These local partnerships would involve three or more public authorities such as councils, NHS, the police, fire services, job centres or even private bodies such as utilities suppliers.

The Lib Dems propose that there should be financial incentives to encourage local organisations to work together, funded “either by top slicing existing funding, or by making new money available”. Although participation would be voluntary, authorities that do not get involved would lose the financial benefits of participating.

This funding should be contributed to by central government departments, the paper said. “This would give local organisations the opportunity increasingly to decide how money would be best spent in their area.”

How the extra cash should be spent would be up to the local better outcome boards, which would have to be led by people who are democratically accountable.

 

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