WIREDGOV

In the revised Operating Framework for 2010/11, published on 21 June, the Secretary of State set out four key tests against which reconfiguration processes need to be assessed.

The revised framework stated that proposals need to demonstrate:

• support from GP commissioners
• strengthened public and patient engagement
• clarity on the clinical evidence base
• consistency with current and prospective patient choice.

Guidance published

The guidance published today (29 July) formalises these tests, asks local GP commissioners, supported by primary care trusts (PCTs), to lead reconfiguration processes locally and to assure themselves, and their strategic health authorities (SHA), that any proposals pass the four tests.

Demonstrating evidence

Specific thresholds for any of the tests are not defined as the Department of Health argues that the process needs to be locally-led and designed. However, local commissioners are asked to be able to demonstrate the balance of evidence and views to their SHA. Once local commissioners have satisfied themselves that proposals meet the four tests, the scheme would then continue to follow the established Office of Government Commerce/National Clinical Advisory Team (NCAT) review, followed by public consultation. Overview and scrutiny committee powers of referral are unchanged.

Where an SHA is not satisfied that the key tests have been met, they can consider halting the proposal and/or seek further advice from NCAT or the Independent Reconfiguration Panel. However, the guidance stresses that local resolution is always preferable.

Flexibility guaranteed 

Flexibility is granted to local commissioners on the level of engagement with GPs in their local area. The guidance states that as GP and practice-based commissioning structures vary across the country, it is up to local commissioners to take an appropriate view about how to gather evidence of support. Similarly, it is also up to local commissioners to decide on the appropriate composition of the clinical body to engage with.

The processes involved in future reconfigurations are provided in more detail in Sir David Nicholson’s letter to the NHS. 

Related publications 
Revision to the Operating Framework for the NHS in England 2010/11 
NHS Confederation briefing 

The triumph of hope over experience 
NHS Confederation report