World class commissioning: this ridiculed plan might just be working

Primary care trust managers are to be congratulated. HSJ’s unique analysis shows the detail behind the second annual assessment of PCTs against the governance standards and organisational competencies encapsulated in the world class commissioning framework. The results are a cause for celebration. Significant improvements have been made since year one. If this process had begun a few years earlier, then the move to GP led commissioning might not be so easy for the new government to insist on.

We must not have a slump in commissioning standards while the new framework is put into place

Whatever the shortfalls of the WCC assurance scheme, and no such measurement regime is perfect or loved, there is much to be learned from analysing these results, as PCT Network director David Stout sets out. Significantly, he claims last month’s white paper’s talk of achieving “world class outcomes” is not a million miles away from the goals of WCC and that GP commissioning too will need some kind of, lighter-touch, assurance scheme.

This is a crucial point. Many PCTs have not traditionally or previously delivered good quality commissioning, for whatever reason, but some are now beginning to. We must not have a slump in commissioning standards while the new system is put into place.

The Department of Health has told HSJ there will not be WCC assurance for PCTs next year. This is a serious mistake - the NHS cannot afford to fly blind during this critical period of cost constraint.

Of course, it may prove politically convenient to pretend PCTs are not improving - or indeed that the WCC standards are not worth bothering with. But the truth is that the people of Hull, Salford and Tower Hamlets - to name the top three performers - are well served by their PCTs. In two years, if improvement continues, the best are likely to be very good indeed and even the “average” PCT would be delivering satisfactory results.

Of course, it is a very big “if”. PCTs might not have the skills to maintain this rate of improvement. It is much more likely that PCTs will be unable to drive improvement because they will be focusing on developing GP consortia to take over.

This should give local authorities, in their new watchdog role, pause for thought.

Will the people of Hull, Salford and Tower Hamlets be better served by a GP takeover? Would it not be preferable for greater GP involvement to be reversed into the existing structures? Would this not be a more reliable way to ensure the progress made was not lost and the learning, corporate memory and talent that underpinned it retained?

Retention of talent is vital. With the publication of HSJ’s analysis, Christopher Long, Mike Burrows and Alwen Williams - the chief executives of the top PCTs - along with their senior teams, will go straight to the top of headhunters’ wanted lists.

Whether it be a role in the national commissioning board, a directorship in a private sector commissioning company or a senior position with a business looking to deliver chronic disease management services into the new landscape, these people will be in demand. Some may stay to become accountable officers within consortia, but many will be more ambitious.

HSJ suggests the GPs of Hull, Salford and Tower Hamlets (together with those from the Tees area, the Wirrall and Hammersmith) quickly organise to make their PCT directors and senior managers an offer they can’t refuse.