In its response to the Future Forum as part of the government’s listening exercise on the Health and Social Care Bill 2011, the Royal College of Physicians (RCP) says that:
- Hospital specialists, and not just GPs, should be appointed to consortium boards and be a central part of all commissioning decisions to make sure patients receive integrated care. Consortia should be renamed Community Commissioning Boards to reflect this broader involvement. GPs should reciprocally sit on the boards of Foundation Trusts.
- Collaboration must be valued more highly than competition, with regulators taking an integrated approach to cooperation, competition, quality and safety. Serious consideration should be given eventually to merging the two main health regulators, Monitor and the Care Quality Commission (CQC).
- The NHS Commissioning Board must formally involve the Royal Colleges in its structures to embed standards, raise quality and promote integrated care for patients across the country.
- The government should postpone any restructuring of education and training for two years, and meanwhile retain postgraduate deaneries to ensure that increasing service pressures do not threaten the training of the next generation of doctors.
The RCP, which represents over 25,000 hospital doctors in the major medical specialties, strongly supports the principle of clinically-led commissioning. Secondary care specialists and other relevant healthcare professionals, such as public health specialists, should be part of planning and commissioning decisions at both national and local levels, and this must be reflected in the Bill. Hospital doctors should be appointed to consortium boards to provide specialist expertise and facilitate the delivery of integrated care for patients.
The RCP’s mission is to set standards, measure, and improve the quality of medical care, and to promote patient-centred care. Quality, collaboration and integration, rather than competition, should be the focus of health service regulators. The current divide between care quality (CQC) and economic regulation (Monitor) could lead to a bureaucratic and disconnected system in which competition becomes more important than standards of patient care. One option could be to merge the two main health regulators, Monitor and the Care Quality Commission (CQC), in order to allow a more seamless and efficient regulatory process.
The RCP is responsible for maintaining high standards of postgraduate education and training for hospital doctors in 30 medical specialties, running exams and education and training programmes. It is greatly concerned that the proposals set out in Developing the Healthcare Workforce do not fully recognise the complexity of medical education and training, nor the potential detrimental effects on patient care, if future structures are wrong. It is important that the postgraduate deaneries (the local bodies that organise medical education)are retained, and that changes are postponed for two years so that any reorganisation is not threatened by increasing service pressures from efficiency savings or destabilisation due to the NHS reforms.
RCP President Sir Richard Thompson said:
The RCP is pleased that the government paused the progress of the Bill to listen to patients and health professionals. We strongly support the move towards clinically-led commissioning, but to make integrated care a reality, hospital doctors must be given a place at the top table alongside GPs. Hospital doctors across the country want to work with their GP colleagues to make sure patients receive the highest quality care, and we need a Bill that promotes this.
Quality, collaboration and integration must be at the heart of the health service and these principles – not competition – should be the focus of health service regulators. We hope to see major changes to the Bill that acknowledge and reflect these genuine and deeply felt concerns, and that the listening exercise will continue, allowing for further input from health and patient organisations.
For further information, please contact Linda Cuthbertson, head of PR, on +44 (0)203 075 1254 / 0774 877 7919, or email Linda.Cuthbertson@rcplondon.ac.uk