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The Health and Social Care Bill, which received its second reading on 31st January, sets in train the establishment of a radical new framework for commissioning healthcare services in England The Bill establishes GP commissioning consortia (which all GP practices will be required to join) as the bodies that will commission the overwhelming majority of healthcare services and an NHS Commissioning Board, which will be accountable for commissioning decisions of GP consortia.

GP consortia will be primarily responsible for commissioning maternity services, although the NHS White Paper had originally proposed that maternity services would be commissioned by the NHS Commissioning Board. The RCM had a number of concerns about entrusting maternity services to GP commissioners:


•    The initial assumption that there would be 500-600 GP consortia led us to the view that individual consortium would be too small to effectively commission maternity services for a local population of maternity service users.
•    In addition extending choice of types of maternity care and eliminating unacceptable variations in outcomes requires some central leverage that is more likely to be achieved via a centralised approach to commissioning.
•    The fact that maternity services straddle primary, community and secondary services are also factors that support central commissioning rather than commissioning by hundreds of separate bodies.

We were, therefore, disappointed when the Government announced in the Health and Social Care Bill command paper that the commissioning of maternity services will rest with GP consortia, not the Commissioning Board. However, two recent developments have given me cause to reflect that the new arrangements can be made to work.

Firstly, there are now likely to be far fewer consortia than was originally anticipated; we are anticipating something in the order of 300 consortia rather than 500 to 600. It is therefore more likely that the size of the population covered by consortia will be more closely aligned to the number of women using local maternity services.  

Secondly, the Department of Health (DH) acknowledge that there are special circumstances pertaining to maternity services, requiring commissioners to take a different approach to that for commissioning other services. So the command paper states that while responsibility for commissioning maternity services will sit with GP consortia, the Commissioning Board will be expected to give particular focus to promoting quality improvement and extending choice for pregnant women by, for example, supporting consortia to work together collaboratively to commission services - consortia will be able to group together, or pool resources with the Commissioning Board, where this makes most sense.

The RCM is interested in this formulation, which suggests a hybrid consortia/Commissioning Board approach to commissioning maternity services. We will be lobbying ministers and testing the forthcoming legislation to tease out how these arrangements can work in practice. For example, is there a role for maternity provider networks in providing GP consortia with expertise about maternity services? Will the Commissioning Board issue guidance or templates on developing maternity services service specifications? How will consortia be held to account for extending choice of types of maternity care? We will be seeking assurances from ministers on all of these issues and will also laying down amendments to the Bill in order to ensure that the policy levers are in place to secure improvements in the quality and safety of maternity services.

We will also be talking to other stakeholders, such as representatives from organisations representing GPs, service users, local authorities and public health bodies, as it is important that a dialogue begins now as to how we can all make commissioning work in the best interests of mothers, babies and their families.

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Written by Cathy Warwick   
Friday, 01 April 2011 00:00
Last Updated on Friday, 01 April 2011 09:35


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