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GPs set to split risk of commissioning with private firms

By Gareth Iacobucci

Exclusive: GPs are set to partner up with private companies to share the risk under the new Government's commissioning plans, under which practices will be asked to take on responsibility for out-of-hours services.



The Tory-Lib Dem coalition last week confirmed its intention to press ahead with a renegotiation of the GP contract, to give GPs hard budgets and the job of commissioning a wide range of services, including out-of-hours care.

A new analysis by the London School of Economics suggests many GPs are likely to hold joint budgets with private firms under the new plans as a way of splitting the risk and workload, while companies themselves said they were already preparing to forge partnerships with the profession.

Andrew Lansley last week confirmed the new Government would be pursuing the Conservatives' long-standing pledge to redraw the GP contract to hand practices responsibility for commissioning out-of-hours services.

But he ruled out a return to the old out-of-hours system under which GPs had to be personally on call, saying groups of GPs would commission services, or else provide them if they choose through co-ops.

‘GPs should be responsible,' Mr Lansley said. ‘There will need to be a new contract to make this point.'

Dr Chaand Nagpaul, GPC negotiator with responsibility of out-of-hours, said the GPC supported a greater role for GPs in overseeing out-of-hours, but warned they needed more detail on how the commissioning plans would work.

‘If we are to move to commissioning out-of-hours and to hard budgets, this has to have sign-up by GPs. We have no detail beyond the hard-budgets headline.'

Zack Cooper, health economist at the London School of Economics and author of a pre-election paper on the parties' NHS plans, predicted GPs would now increasingly enter into partnerships with the commercial sector, since many did not have the capacity or inclination to manage real budgets on their own.

He said: ‘We will see companies coming and helping to manage GP practices. Some GPs want to [commission] themselves, some don't. The ones who don't will say: "let's bring in somebody else. I'll focus on medicine, you focus on commissioning".'

Humana, which has worked with the NHS Alliance in offering commissioning support for GPs, said GPs would ‘welcome the idea' of holding joint-budgets with private firms, as it would give them greater purchasing muscle.

A spokesperson said practice-based commissioning consortiums ‘feel hampered as it stands', and often struggled to secure funding for innovative proposals.

Jeff Anderson, director of primary care and PBC lead at Tribal, which has provided commissioning support to PCTs under the previous Government's Framework for Procuring Exernal Support for Commissioners (FESC), said a risk-sharing contractual model was 'very attractive' to the company.

He said: 'We're having discussions with different GP consortias around hard budgets, and models we might use.'

New health secretary Andrew Lansley Health policy and the new government: an analysis

Click here to read a detailed analysis of how the Tory-Lib Dem coalition will affect general practice .

Click here to read a detailed analysis of how the Tory-Lib Dem coalition will affect general practice . Andrew Lansley

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