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Commissioning dilemma - the chance to join a more affluent and successful commisisioning group

Your practice has historically always worked together with its neighbours in a deprived area of town, but has now been offered the chance to work with a more affluent and successful group next door. Dr Helena McKeown offers GPs advice on what to do.

Your practice has historically always worked together with its neighbours in a deprived area of town, but has now been offered the chance to work with a more affluent and successful group next door. Dr Helena McKeown offers GPs advice on what to do.

The advantages of working with our neighbours is that we already have an established professional relationship; the channels of communication are already there, we understand each other's strengths and weaknesses, we can hit the ground running and have mutual trust. Trust takes time and the decisions ahead of us are going to be hard. The advantage to the local town is in ensuring health inequalities are not widened.

The disadvantages to our practice is that we will probably have to work harder to keep within our commissioning budget - such a patient population is highly demanding of health and social care. There are potentially disadvantages to our patients too, who may have reduced access to secondary care and medicines because of the high level of care needed by the residents from the deprived area.

The advantages of working with the more affluent and already successful group next door include the easiness of picking up on what they are doing; our patients seem likely to gain from sharing a commissioning budget with less needy patients and we might gain from the proposed quality premium because superficially it looks much easier.

On the downside we have less ownership as we weren't in on the original plans and do not have a shared ethos going back years. Furthermore, what happens if we don't get on? When difficult decisions about decommissioning need to be made we might fracture resulting in a real risk of the NHS Commissioning Board dissolving us.

The altruistic choice is definitely our historic partners, but the best political and longer term strategic answer may be to negotiate both us and our historic allies into the group next door.

Dr Helena McKeown is a member of the GPC Commissioing and Service Development Sub-committee, and GPC member for Wilts and Dorset.

Dr Helena McKeown

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