NHS must think local

18 January 2011
I feel passionate about procurement in healthcare, so I want to offer my insight on comments in the SM article Upping the dose (25 November) even if I run the risk of abuse from my peers. The article covered a UK government white paper which proposes huge changes to the delivery of healthcare in England, and how this may affect procurement. It said the white paper aims to realise £20 billion savings by 2014; procurement expertise must be harnessed to support GPs ‘who lack the expertise to do it’; and that procurement has key role to play in driving efficiencies in the NHS. I agree with the latter two statements, but would challenge the solutions offered in the article and already in existence today. In terms of the aim of the white paper, a wider objective has been overlooked. One of the most significant outcomes will be changes in budgetary responsibility. GP consortia will decide what care is provided for, who will provide it and potentially how much it should cost. This will arguably move our health system towards a free market as GPs come under pressure to manage patient outcomes and meet efficiency targets. Acute trusts and private providers will need to work even harder to deliver their services more cost-effectively. This is where procurement has a role to play. However, recycling the commissioning expertise in PCTs is not the solution. Currently, commissioners operate within a restricted market which limits the need to understand market economics and develop procurement strategies. Experience of buying in competitive markets with varying degrees of supply risk will be important. The introduction of procurement professionals from outside PCTs to work with GP consortia is essential if taxpayers are to get better value for money. The skills used to buy goods and services for NHS Trusts are different to those required in GP consortia. Over the past two decades the fascination with ‘big is beautiful’ and ‘leveraging scale’ has dominated the drive for efficiencies. Has this been the most effective route to achieving best prices across the NHS? A straw poll would probably show a mixed view on whether the NHS Purchasing and Supply Agency, regional procurement hubs, NHS Supply Chain (DHL), Buying Solutions etc, are, or were, value for money. Procurement in healthcare is a tough gig. The globally dominant supply base and clinician preference issues often defeat initiatives that require ‘buy-in’ across trusts. It’s doubtful whether best prices can be achieved without the full mandate for the buying organisation to manage the supply base. To do this, clinician preference issues must be tackled head on to create more competitive tensions in the supply base. This is best done locally rather than through scale. Free buyers from centrally led edicts, reward and develop talent to attract and retain the best, and drive local initiatives with the private sector to offset restrictions created by OJEU regulations. A Big Society in healthcare, if you will.
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