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Health reform in England: update and commissioning framework

GPC summary/analysis of new policy developments in relation to PBC
August 2006

1. Background
The Department of Health published ‘Health reform in England: update and commissioning framework’ on 13 July 2006, which can be accessed online - go there now.

On 29 August 2006 the Department of Health produced a summary of the key points for practice based commissioners; see appendix 1. This two-page document will be loaded on to the Department of Health website, under the ‘news’ section in due course.

The Kings Fund published a briefing on the commissioning framework earlier this month, giving a useful summary of the document and which can be accessed online - go there now.

The commissioning framework provides an update about health reform and focuses on commissioning NHS services, in particular hospital services. It builds upon ‘Health reform in England: update and next steps’, published in December 2005. In terms of practice based commissioning (PBC), it sets out to build upon and add clarity to Department of Health guidance issued earlier this year, ‘PBC: acheiving universal coverage’ (January 2006).

This commissioning framework is split into two parts; the main document and an annex, which contains the bulk of information relevant to local medical committees (LMCs) and GP practices. This General Practitioners Committee (GPC) analysis seeks to highlight the new and/or important developments in policy that will be relevant to GPs/LMCs.

Certain parts of the framework are currently open for consultation (deadline 6 October 2006), they are as follows:

Choice (pages 19-20 of main document)
The Department of Health is seeking to publish a framework in the autumn which will set out the next steps in extending choice in both elective care and other service areas. In addition to the Reference Group already set-up by the DH in order to steer this policy development, this consultation will also help to inform the process.

Contracting for NHS care (appendix C of the annex)
This section sets out proposals for a new ‘national model contract’ which PCTs will use to procure services from all NHS Trusts, NHS Foundation Trusts, independent and third sector providers as covered by the national tariff/Payment by Results (PbR). The current timescale is to publish this model contract in the autumn in time for the 07/08 contracting round.

PBC governance and accountability framework (appendix D of the annex)

Triggering community action (appendix E of the annex)
The White Paper introduced public petitions as a 'trigger' for community action. It is envisaged that primary care trusts (PCTs) will respond to public petitions. This consultation will inform further/ongoing work within the Department of Health to develop specific mechanisms and thresholds for public petitions.

The GPC is coordinating the BMA response to these consultations in liaison with other BMA crafts, the Health Policy and Economic Research Unit (HPERU) and the BMA’s patient liaison group (PLG). [Note that the specific proposals outlined in the consultations have not been covered in this document as the arrangements are yet to be finalised.]

In light of the fact that this is becoming an increasingly complex area of policy, we believe that there needs to be a two-pronged strategy: first, to try to influence and ultimately change overall Government policy, which is primarily a BMA task; and second, to try to modify the particulars of that policy into as coherent an implementation as possible, which we will endeavour to achieve through the BMA’s response to the current commissioning consultations (and any future consultations). This does not however preclude the GPC from looking at the detail of new policy as it emerges and trying to simplify it in order to help GPs put new developments into practice