Of course you shouldn't believe everything you read in the papers, but after I voiced my view that the ultimate aim was to transfer health commissioning to Local Authorities, Health Service Journal reported that their mole in Department of Health had said the same thing, or at least something similar:
"Could the government have a plan B if GPs decide not to play ball on GP commissioning? Perhaps.
One minister confided to an HSJ reporter during an evening reception that "If the GPs don't want to do it, we'll get the local authorities to take on commissioning. They're really keen".
Health Service Journal - 14 Oct 2010 EndGame p33
I've long argued that health and care needs to be commissioned by a single organisation, AND that that organisation needs to have elected representatives with the power to call the executives to account.
PCTs (Primary Care Trusts) refused to allow locally elected members on their boards (HSJ published a long editorial explaining why this couldn't be done - it seems that NHS is too complicated as it operates at Local, Regional and National levels. Their point? I thought that's how government worked?).
So the natural response is to move health commissioning directly into the Local Authority/ Local Government. They have plenty of experience of commissioning from multiple providers (a plurality) and for commissioning innovative new pathways of care, and even for commissioning in competition with in-house services.
But in UK we have laws about this, the most significant being TUPE (Transfer of Undertakings - Protection of Employment). What this means is that those who commissioned so badly for PCTs (see Civitas report mentioned in the previous article) would automatically be transferred to the new commissioning body. What's more, they would get the better of either their new employer's pay and conditions, or their old ones, regardless of their previous performance.
So the most likely scenario is that commissioning will pass to GPs, and with it, a clear understanding that the staff will not transfer under TUPE. Then the GP commissioners will fail because they don't have the management or the budget to recruit management to deliver commissioning. Then the service will be transferred to Local Authorities without the TUPE.
your average service company has to forecast the likely requirement for its service and staff up accordingly. But it charges a risk premium for this. In order to avoid a risk premium on 36million hospital activities per year, PCTs do their own forecasts and set contracts for volume, at favourable prices, effectively taking on the risk themselves. So it is a money-saving exercise - when it is done properly.