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
will be accountable to the Commissioning Board and will have performance
indicators against which they will be held to account.
GP consortia will receive an allowance of about £35 per head
of population for their running costs.
So far, the Department has announced the formation of 141 'pathfinder'
consortia which will be established in shadow form from April
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. The
Department said that part of the purpose of the pathfinder process
was to address questions about the right size for a consortium.
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.
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.
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.
21. There will be an intervention regime for failing
GP consortia, which the Department has yet to develop.
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.
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.
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.
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.
35 C&AG's report para 2.11 Back
C&AG's report para 2.15 Back
C&AG's report para 2.15 Back
Q120,125, 141 Back
Qq 117-119 Back