Protect Our NHS – Straws in the wind

This is a quick round up of some issues that are likely to shape the NHS after the Health and Social Care Act comes into effect from 1 April 2013:

  • Freedom of Information
  • GPs freedom (or not) to disagree with their Clinical Commissioning Group
  • Privatisation of Commissioning Support Units ( the organisations that are supposed to support Clinical Commissioning Groups)


Freedom of Information

The Freedom of Information (FOI) law requires the NHS and all organisations providing primary health or dental care for the NHS to provide journalists and the public with information that they request, with some exceptions, eg personal data.

The Information Commissioner is inviting people to submit questions about how the Health and Social Care Act will affect FOI when it comes into force on 1 April 2013. The Information Commissioners Office (ICO) says that the Act will not only affect health bodies, but will also have a significant impact on FOI.

They are asking people to email their questions to:Consultations@ico.gsi.gov.uk including ‘NHS Transition Internal ICO Policies’ in the subject line.

Even before the Health & Social Care Act has taken effect, changes to the way NHS provides health care have led to attempted restrictions to the public’s right to obtain information about the workings of the NHS.

In May 2012 the Huddersfield Examiner reported that the new Kirklees community care provider, Locala, refused to answer Freedom of Information requests on the grounds that it is a social enterprise and so is not required to provide information under the FOI regulations.

This is despite the fact that FOI regulations require all public agencies and companies that deliver contracts for them to provide information when requested, with certain exceptions eg not releasing personal data. Locala may be a social enterprise but it’s still a company.

GPs contracts and Clinical Commissioning Groups

An article in GP Online reports that a British Medical Association lawyer has warned of a possible change to the General Medical Services (GMS) contract. This contract defines the employment conditions of NHS GPs.

She said that the contract change, if introduced, could mean that GP Practices which didn’t support their Clinical Commissioning Group (CCG) and abide by its commissioning decisions would be in breach of their core contract and could be served with notice of its termination.

Two points in Section 28 of the Health & Social Care Act state that GP practices must:

  • support their CCG
  • abide by its commissioning decisions

These points are not currently included in the GMS contract, but BMA legal adviser and barrister Shanee Baker said last week at a London Local Medical Committees conference that it was likely that the Department of Health would watch what happens after 1st April when CCGs take over commissioning. If the Department thinks GP Practices are not cooperating enough with CCGs, they may try and add the two Section 28 requirements to the GMS contract.

Shanee Baker said, “ We are hoping those points won’t go in.”

Planned privatisation of Commissioning Support Units 

An article in Health Service Journal (free sign up required to read their articles) reports on the views of Bob Ricketts, the NHS Commissioning Board’s director of commissioning support strategy, regarding the proposed privatisation of the Commissioning Support Units (CSUs). He calls it “externalisation”, which is privatisation by another name.

Bob Ricketts is reported as saying that for the first two to three years, from 1st April 2013, the NHS Board is considering ‘light touch regulation’ of commissioning support. He sees the commissioning support sector as a ‘mixed competitive market’ that includes:

  • the CSUs (the regional NHS organisations that are supposed to provide commissioning support to the Clinical Commissioning Groups in their area)
  • the private sector
  • Clinical Commissioning Groups (CCGs) providing support services to other CCGs

Bob Ricketts considers that after two or three years of this lightly regulated commissioning support market, it will be time to consider privatising the CSUs. But his current priority is to create the market for commissioning support. He says that once this market has been created, the CSUs will be “barely recognisable” compared to the organisations that are currently being developed.

Light touch regulation was applied to the financial services sector when markets for new financial products such as derivatives were being created. Light touch regulation was also the mantra of the Food Standards Agency. Light touch regulation seems to be code for letting private companies do what they want, without regard for the effects on the public sphere. Patients beware.