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External consultants - the challenges and opportunities

Editor Sue McNulty puts the role of PBC consultants into context

Editor Sue McNulty puts the role of PBC consultants into context

External consultants working in the NHS have had a bad press of late.

Practical Commissioning's sister paper Pulse reported in May how PCT spending on management consultants has more than tripled in the past two years.

Its investigation found that where two years ago PCT expenditure on external consultants averaged £360,000, this figure had ballooned two years later to an average of £1.2m – or even more, when you factor in professional services and legal fees.

World Class Commissioning has undoubtedly been responsible for a significant proportion of these consultancy fees. Filling staff vacancies as pressure grows on PCTs to move their commissioning skills up four gears or so, has also been cited as another reason for buying in external help.

In the current economic climate, as the NHS strives to make £10.5bn of savings over the next couple of years, questions over the use of external consultants are already being asked.

The Commons health select committee recently called for the Government to keep a central record of all money spent on management consultants, and for a sample of contracts to be subject to regular external peer review.

Looking at the examples in this edition though, it is hard to argue there is not a place for external companies that are able to stand the test of such scrutiny.

External consultants not only supply the necessary skills that are not available in-house but the power of a third voice in the room. Given the differing perceptions PCTs and GPs often have regarding PBC, this aspect cannot be underestimated.

The Runcorn case study is an example of how this third voice has moved PBC several steps forward. The GPs no longer feel that they are constantly complaining. They are remunerated for the work they do and there are six core GPs now steering the ship and making the big clinical commissioning decisions. Another benefit of using consultants is that they can be used for short, sharp bursts rather than the long-term commitment of employing staff.

The article on where the PBC group successfully bid for the GP-led health centre shows how external consultants were used appropriately.

The GP and practice manager who co-ordinated their bid both had demanding day jobs but were pragmatic about the time they had available and bought in consultants to do the groundwork of the bid.

Of note is that their PBC consortium had bought in external help on a number of previous occasions and so was experienced at negotiating short contracts.

This example, along with the feature where a Surrey PBC group has entered a partnership with an external organisation to manage a £59m capitated budget, shows how PBC can reach its potential when external consultants are brought in.

The headline figures PCTs spend on consultants might be hard to digest, especially for GPs having to rein in referrals and prescribing. But where their use is appropriate and able to stand up to scrutiny, external consultants can enhance PBC.

Sue McNulty is editor of Practical Commissioning

Practical Commissioning editor Sue McNulty Sue Mcnulty

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