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NAPC chair embroiled in democracy row between commissioning pioneers and grassroots GPs

By Gareth Iacobucci

Exclusive: National Association of Primary Care chair Dr Johnny Marshall is at the centre of a row between grassroots GPs and pathfinder consortia, as tensions emerge over the imposition of the Government's NHS reforms.

GPs in Buckinghamshire and Berkshire have accused a number of consortia, including one run by Dr Marshall, of pushing ahead without a democratic mandate and of a lack of consultation on commissioning decisions.

Local LMC leaders said some of their GP members were concerned about the lack of input they were being given into the development of the consortia – and some of their commissioning decisions on specific areas such as a redesign of musculoskeletal services and enhanced service development.

The BMA has urged LMCs across England to organise elections for consortia to secure the democratic backing of all GPs, but the NAPC has argued GPs at the leading edge of commissioning should spearhead the Government's reforms.

Buckinghamshire already has three GP commissioning groups which existed as legal entities prior to the white paper, the Buckinghamshire Primary Care Collaborative, United Commissioning and a group formed by private firm the Practice PLC.

Since the white paper, the three consortia have established a transformation team to move to GP commissioning, which is reviewing every function to determine how to deliver it in future, including value for money, productivity, reduction of duplicatio, and clinical outcomes.

Dr Marshall, chair of the United Commissioning group and NAPC chair, said the consortia would address the concerns of local GPs, but warned the issue was more complex than simply holding elections.

He said: ‘We will need a degree of elected representation to ensure we have connection with the grassroots. But then we'll need to recognise what additional skills we might need to work in that leadership team. That will need to be a selection rather than an election, in order to deliver against their accountability.'

The group, which includes invited representatives from the PCT and the local council, has already begun reviewing areas such as medicines management, shadow budgets and IT, and could recommend purchasing services from an independent provider in the future or discontinuing them.

Dr Paul Roblin, chief executive of Buckinghamshire, Berkshire and Oxfordshire LMCs, said: ‘The LMC felt that the new Bucks commissioning system had communication issues which needed to be addressed. There were concerns expressed about the commissioning for the MSK redesign. The specification had been approved by the consortia but grassroots GPs had not been consulted.'

He said members were concerned about an ‘absence of openness' from emerging consortia.

‘It's important consortia get a good democratic footing and that means not making assumptions that previous organisations automatically morph into new consortia.'

‘I've had various reports in Buckinghamshire and Berkshire from some practices who weren't happy with the way their locality was dealing with these issues. There appeared to be an absence of information, openness and seeking of any mandate in some areas.'

He added: ‘Everybody is concerned that whoever they elect to take these decisions has been chosen by constituent practices with the right criteria. This is not just a beauty contest.'

Dr Johnny Marshall: Consortia leadership will need selection as well as election Dr Johnny Marshall: Consortia leadership will need selection as well as election Essential Commissioning Skills seminar

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