Posted by: Tony Shannon | March 30, 2013

Commissioners and Providers

Within the next few days one of the most significant changes to the National Health Service comes to England.

From the 1st April, the NHS Commissioning Board (based in Leeds, England) formally takes over the running of the NHS. While it has been up in shadow format for some time now, this move is a landmark in the history of the NHS.

While it can be very difficult to comprehend all the changes in detail and while it is the subject of much debate within the NHS, what it key is the *split between the commissioning and the provision of healthcare*.

The NHS is a publicly funded healthcare system, i.e. paid by taxes. Over previous decades there have been previous efforts to develop an internal market within the NHS to promote competition has taken several forms (eg GP Fund Holding).

This latest initiative aims to promote, within the public sector, 2 separate sets of skills .. around the commissioning of services (the analysis and buying power)
..another of the provision of services (the production of services and their related sales ).

There are similarities in this model and that of the social/healthcare insurance models that are seen elsewhere in the world..
..where the insurance companies generally act in that buying role ,
..while healthcare providers provide..
..and patients shop for the care they need/want.

My understanding is that there is a subtle but important difference seems to be part of the commissioning/provider split…
.. that commissioning should be done in advance to help project the value and cost of care by local area/clinical condition etc.
So there is a prospective planning aspect to the idea. Which should in theory help foster a different ecosystem than others..

It is assumed that the move should promote the funding of evidenced based care and hope to avoid unnecessary healthcare activity which does not improve clinical outcomes yet adds costs to the healthcare system.

Looking beyond the current changes, if one looks at other business sectors, my instinct is that this split is here to stay, whatever model of healthcare funding you use.
It is clear that as Walmart , Amazon , Tesco etc have shown how the retail trade has been shaken up entirely within the last century, so too will such changes come to healthcare.. most likely to the provision of healthcare in some shape or form as we are already seeing in many countries.
If “HealthMart” the global healthcare provider comes to be any time soon..then what will also be needed will be skills and expertise to oversee and govern such providers of healthcare.
Healthcare cant easily be purchased by the layman without some independent guidance and advice on how ones money should be spent.

So my sense is the role of commissioners in healthcare, in some shape or form is  here to stay…



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