Department of Health director-general of commissioning Mark Britnell has promised “to professionalise commissioning in 18 months, and test strategic and operating and development plans over the next three to five years”.

Commissioning (which is basically the local planning and purchasing of health services) is central to the Government’s plans for NHS reform. The recently-announced FESC (framework for external support for commissioning) listed 14 companies accredited by the Department of Health to sell their information and management services to support the commissioning PCTs and GP practice consortia.

Speaking at the recent NHS Alliance conference in Manchester, Britnell guaranteed that PCTs “will be accountable next year for practice-based commissioning support”, but, he added: “you don’t need to imagine too far ahead to see how practice-based commissioners could be uber-modern English health maintenance organisations." HMOs are the US organisations which offer health insurance programmes – as seen in the recent Michael Moore film ‘Sicko’.

Britnell told the conference: “The irony is that ‘world-class commissioning’ can only be world-class if it's local … This is a profound trust. Don’t blow it”, and he also told delegates: “we’re building the system with you, not doing it to you.

Making a difference?
Meanwhile, Professor Donald Light, a bioethics expert from the USA and acknowledged authority on the NHS, warned that the companies offering commissioning support in the NHS may have little evidence that their products and services will make a real difference.

Light observed that although some of the FESC participants had some involvement in commissioning and risk-based measurement going back 25 years, they offered him no meaningful evaluation or longditudinal tracking. They were mostly selling new products, developed in the last two years, which “clearly don’t have much evidence”.

Light noted the danger of importing greater risk selection, stating that “the US experience over the last 30 years is about rationing care to those people at highest risk. Risk-selection can be enlightened if it means enabling the low-income sick to obtain healthcare cover, but the long history of US insurers is otherwise. Be careful!”

He also noted the paradox that managers are being told in no uncertain terms by central government that they will use commissioning, calling it “dictated competition”.

By Andy Cowper