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At the heart of general practice since 1960

Consortia must involve small practices

GP commissioning has been labelled the most revolutionary change in the NHS since its creation in 1948.

Hopefully doctors will no longer be hindered by red tape and will be able to develop fresh ideas to bring treatment closer to home.

However, the policy will also give consortia large powers in decision making on which practices benefit and which are ignored. General practice has gone through constant changes since most of us became GPs. One thing has been common to all these changes – the number of small practices has dwindled. Practices involved directly with PCT management have benefited greatly at their expense.

Small practices have to be very careful before joining a consortium. They should enquire about its collective ideals and goals, and views on some of the following issues:

1. Engagement of practices

The consortium GP committee should ideally involve all practices, giving them an equal role. This will ensure mutual respect and a level playing field. There is a risk some consortia may engage practices only via a member of the management team, putting a second layer between the committee and practices.

2. Decision making

How will the consortium decide on issues of development and division of resources? In the past, PCTs have used various formulas for decision making, such as voting by all constituent practices either by number of principals or list size. The process should be agreed from the beginning and should not be changed issue to issue, ensuring organisational integrity.

3. Development of new services

How will the consortium decide on the development of new services and division of resources?

Will the resources for development be equally divided between practices on a prior agreed formula, such as either patient list size or GP numbers?

And will practices be allowed to develop services equally? This will ensure development of smaller practices along with bigger ones.

4. Conflict of interest

What arrangements will be in place to overcome conflict of interest? If members of the management team are themselves bidders for services and resources, what procedures will be in place to ensure justice is seen to be done?

5. Safeguarding small practices and ethnic-minority GPs

How will the consortium involve and safeguard small practices and those run by ethnic-minority GPs?

Early indications are that small practices and GPs of ethnic minority are not being elected onto management teams. Will there be a process for ensuring small practices and ethnic-minority GPs are given equal voice in the new world?

6. Engaging with difficult practices

How will the consortium engage with difficult practices?

In the past, very little chance has been given to single-handed practices and those seen as difficult to put forward their views to the management structure.

How will the consortium prevent an unnecessary witch hunt, since the closure of small practices might be of benefit to other practices in the consortium?

It may be necessary for smaller practices to meet outside their consortia to support each other. Perhaps the Family Doctor Association could also employ experts to advise small practices in negotiations with their consortia.

From Dr Mohammed Salahuddin,
Birkenhead

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