Thread by @petermbenglish

CCGs to be replaced as commissioners by ICSs, under NHS England proposals pulsetoday.co.uk/news/nhs-struc…
@jkaffash @costanza_fierce
The wheel continues to rotate…
1/8

They keep creating bodies in which trusted GPs are the commissioners; and they keep ensuring that they fail and revert to being something like a 1980s Health Authority...

I wrote about this in BMJ 10 years ago. bmj.com/content/340/bm…

2/8

"Politicians realise that people trust their general practitioners more than politicians or faceless commissioners in the health authority, primary care trust, or whatever the organisation is called at the time…
3/8

"… a few enthusiastic GPs with an eye to improving services for their patients—and, possibly, their income—actively campaigning to do it better than the existing commissioning body; changes are made so that all GPs have to commission; …
4/8

"and the enterprise fails because, once everybody has to do it, the incentives to a few pilot practices disappear, and, anyway, most GPs are more interested in being GPs than commissioners."
5/8

Do you remember how, when PCTs were first created, they were far too small to function effectively? So they merged, and they merged…
6/8

I started my current job (as a CCDC) in East Surrey Health Authority in Feb 1998 (I've been TUPEd or equivalent several times since!), having been assured at my interview that the two Surrey HAs would merge within a year or two.
7/8

Well, they were abolished and FIVE PCTs were created to replace them. And then they merged to become a single, Surrey-wide PCT, with a popn of just over 1million - about the right size for all but specialist commissioning.
8/8

@threadreaderapp unroll