Buried in the small print of last year's health white paper Our health, our care, our say is a provision for GPs to use practice-based commissioning to buy social care.
This small but significant comment has lain largely unnoticed since then - until, that is, the Department of Health published its consultation document Commissioning for health and well-being in March. This refers approvingly to primary care trusts and councils commissioning services together and GPs buying social care
Although the NHS has long had the power to transfer funds to other agencies to provide services, this consultation document envisages it applying in a wider set of circumstances and affecting many more people. The PCTs and the practice-based commissioning GPs will simply need to satisfy themselves, the document advises, that services would prevent illness or care for someone who is ill and be regarded as an appropriate part of the NHS.
This is a pretty broad definition by anyone's standard. The consultation document cites examples of GPs being able to pay for stair-rails to be installed in homes, short breaks for older people with dementia and schools to employ mental health nurses. It both provides real opportunities for patients and contains problems that will have to be resolved on the ground.
The document allows for some of the very significant investment in the NHS over the past six years to be shared with social care commissioners, who generally have had much lower levels of increase in funding. Budget problems need no longer be show-stoppers. It also allows commissioners to deliver health and social care at the right time at the right place, and supports the policy aim of moving some treatment out of large acute hospitals and into the community.
However, the notion of GPs buying social care has its difficulties. Take, for example, the idea that the NHS will pay for stair-rails. Most directors of adult social care will see this as something they have a duty to provide.
How will health and social care commissioners decide a local authority is purchasing a reasonable number of hand-rails, before the NHS decides to top this up? Already some councils are providing services only when clients are deemed in critical need, whereas others are bravely persisting with care for those in only moderate need.
Will patients be means-tested to determine if they have to pay for hand-rails funded by NHS and councils? The low level of proof proposals have to meet before the PCT will fund a scheme might add significant cost pressures to healthcare budgets.
To grasp the prize, the way forward is to develop more pool budgets, as permitted by the Health Act 1999, and to determine appropriate levels of social care funding before considering applications for additional health money.
Joint commissioning between councils and PCTs is not just about setting the overall framework and sitting back waiting for practice-based consortiums to come forward with business plans.
Councils, as well as trusts, need to be working alongside GPs to develop business cases for new schemes that enable health and social care resources to be used more effectively.