Providers will be the innovators

by Rob Findlay

The NHS Chief Executive’s round robin on the White Paper will disappoint anyone who spent the summer holidays hoping it would all go away. After many kind words to those facing the axe, he laid out the message loud and clear: devolution, devolution, devolution.

Most of the attention around the White Paper so far has focused on commissioning: the dramatic abolition of SHAs and PCTs, and putting GPs in charge. Debates have raged about GP incentives, and whether they will have the skills to do what PCTs do now.

But this lopsided attention is curious because GP commissioning is not where most of the change is going to come from, nor where a lot of the PCTs’ current expertise will be needed. The Chief Executive’s letter recognises this, calling for “particular attention locally” towards:

The proposed changes to the provider system, where I think the extent of the changes and the freedoms and opportunities to innovate are particularly significant;

A quick glance at the outside world shows that this must be correct. Who are the innovators who create the latest cars and phones? Not the customers who buy them, that’s for sure. It’s people at Toyota, Apple, and the rest who identify the gaps in the market, spot opportunities to innovate, and design and produce the latest new products. We, the consumers, merely choose whether or not to buy them.

So it will be in the NHS. Providers will innovate, GPs and patients will choose.

This is not to belittle the importance of GPs and patients; they are the customer, and the customer is king. Nor does it imply that a choice of providers must exist everywhere for everything; the fact that new providers could set up a better service will keep the incumbents on their toes.

But it does mean that GP Consortia should think twice before taking on everything their PCT does at the moment. If it helps them balance the books or refer to different providers, then fine. But if it’s heavy analysis around demographics or disease prevalence that’s on offer, then a polite shove towards the provider market might be more sensible.

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