GP commissioning – what will it look like in five years?

Dr Michael Dixon takes a look at the best and worst case scenarios for the Government's plans on GP commissioning in 2015

In five years, primary care trusts and the strategic health authorities will be long gone, and GP consortiums will be responsible for deciding what local services are available, procuring those services and ensuring that they stay within budget.

Here I look at how this could play out in practice.

Best case

2015. All the GPs in Everytown are part of the local consortium, covering a population of around 100,000 people. They are still using the same acute trust, but are working together more closely in shaping and improving that trust's services.

After the initial difficulties of working together so closely, local GPs are starting to feel that they can have a real positive impact on their patients' lives outside the consulting room – whether it be in improving services, local health or making better use of NHS money.

The Commissioning Board has thus far been remarkably ‘light touch', recognising that the GP consortium knows what it is doing. Everytown Local Authority also sees the importance of general practice as both commissioner and provider of improved local health.

Dr A. Verage has just finished his morning surgery and he is preparing for a meeting with his local consortium, when the phone rings.

‘Alvin, we need your help.'

‘Of course.'

‘We are reviewing our contract with Everytown Hospital to provide cardiac rehabilitation. Their costs are continuing to increase and I think we can do better in-house. Your community ultrasound service was such a success, can you help us develop a proposal?'

‘Absolutely. Shall we discuss it at the meeting today?'

‘Great – thank you.'

Dr Verage is one of two GP leaders working with one or two senior managers to run the consortium. The Chief Executive and the Finance Directors are part of the consortium, but also work for several other GP consortiums in the county.

Everytown GP Consortium is systematically developing plans to redesign local health services. It has already shifted the bulk of dermatology services and cancer diagnostics into the community, using services developed by practices in the area.

It has also re-tendered its out-of-hours care to a social enterprise with an impressive record on cost-effective and safe urgent care run by GPs in a neighbouring county.

The consortium also monitors the contracts of primary care clinicians in their area – using peer pressure of fellow GPs to improve the standards of local general practice.

GPs from the consortium also sit on Everytown Local Authority's ‘Health and Wellbeing Board'. This determines where ring-fenced funds for improving local health are directed and ensures that some of these are used to extend the ability of local general practices to improve the health of their patients.

They have recently started work on improving the mortality rates from COPD in their area, which are considerably higher than the England average.

Worst case

In Worse Caseville, the GP consortiums are not working so well. After being coerced by the NHS Commissioning Board to work together, local GPs have reluctantly formed a consortium.

Those leading the consortium are enthusiastic, but they are ‘them' in the eyes of local GPs and practices and are more oppressive than the worst PCT or SHA.

The NHS Commissioning Board is overbearing and is asking the impossible of its straight-jacketed GP consortia and local councillors dispute every plan produced by their local GPs.

Budgets are routinely overspent and general practice has become the fall guy for insufficient funding. The GP-patient relationship has become fractured and suspicious.

The Daily Mail is running a campaign saying GPs have ‘failed the NHS' and commissioning should be taken over by private companies.

Both these worst case and best case scenarios are both theoretically possible and possible together. Many consortia in five years will represent the best case while the worst may be taken over by other consortia or be run by outside management teams serving unhappy and alienated GP practices.

But the outcome in five years will be only partly dependent on the original concept. Mostly it will be up to those, who will be required to play the major role in that change – the GP commissioners.

I believe general practice is highly intelligent, infinitely pragmatic and adaptable and that it must lead and that it is fit to lead. But there is also another scenario of how this could play out.

Dr Michael Dixon is chair of the NHS Alliance

The clock is ticking the end of the consultation on proposals on next Monday for the health white paper - Liberating the NHS: commissioning for patients. With the end looming, there is still a huge amount of uncertainty within the healthcare community, with questions being thrown up around the work and responsibilities that will be involved in the ‘new' NHS.

Come to the NAPC Annual Conference to hear from Andrew Lansley, secretary of state for health and help answer your pressing questions.

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