National Health Service Landscape Review - Public Accounts Committee Contents

3  Establishing effective GP commissioning

17. The majority of commissioning will be undertaken by GP consortia, from budgets allocated to them by the NHS Commissioning Board.[35] Consortia will be accountable to the Commissioning Board and will have performance indicators against which they will be held to account.[36] GP consortia will receive an allowance of about £35 per head of population for their running costs.[37] So far, the Department has announced the formation of 141 'pathfinder' consortia which will be established in shadow form from April 2011.[38]

18. The size of GP consortia is determined by the GP practices which form them. The 141 pathfinder consortia range from one to 105 practices, covering populations of between 14,000 and 672,000.[39] The Department said that part of the purpose of the pathfinder process was to address questions about the right size for a consortium.[40] Dr Gordon acknowledged that there was a tension between achieving economies of scale as a large consortium and remaining responsive to the needs of individual patients. However, he considered that one of the benefits of clinical leadership in consortia was the trust that develops between the leaders of the consortia and their peers in the practices.[41]

19. We asked the Chief Executive of the NHS how small GP consortia would deal with patients with expensive, rare conditions. He told us that the Commissioning Board would run a series of 'risk pools' as insurance, which consortia would pay into in order to cover the needs of such patients and that the Bill allows consortia to ask the Commissioning Board to take responsibility for some of its activities.[42]

20. In the transition from PCTs to GP consortia the Department's aim is for PCTs to pay off any debts over the next two years, so that by the first full year of operation in 2013, consortia do not have any legacy debt attached to them. The Department acknowledged, however, that this may not be possible in all cases.[43]

21. There will be an intervention regime for failing GP consortia, which the Department has yet to develop.[44] This may take the form of 'a rules-based stepped process' beginning with a consortium being issued with performance notices and ending with the removal of its right to commission.[45]

22. GP consortia will not commission primary care services, which will be the responsibility of the NHS Commissioning Board. Dr Gordon foresaw some difficulty in redesigning primary care services, where this was needed, from the current very fragmented service of small GP practices, using the 'large scale commercial levers' available to commissioners.[46]

23. The NHS currently has wide variations in the services patients receive in different parts of the country - for example, there is an eight-fold variation in the extent to which GPs refer their patients to cancer specialists. The King's Fund told us that it had looked at many different examples of these variations which seemed to be unexplained by factors such as differences in population. The King's Fund believed that GPs' new role under the reforms could help to reduce such variations, through more effective peer engagement.[47] The Chief Executive of the NHS said that equity of treatment would be the responsibility of the NHS Commissioning Board. National quality standards would be set out in guidance for consortia.[48]

35   C&AG's report para 2.11 Back

36   Q237 Back

37   Q101 Back

38   C&AG's report para 2.15 Back

39   C&AG's report para 2.15 Back

40   Q120 Back

41   Q236 Back

42   Q120,125, 141 Back

43   Qq 117-119 Back

44   Q238 Back

45   Q239 Back

46   Q267 Back

47   Q246 Back

48   Q154 Back

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Prepared 27 April 2011