Nicholson: Consortia must take ‘tough decisions’ and hire best PCT staff

By Gareth Iacobucci

GP consortia face a bleak financial future unless they retain a proportion of existing PCT staff under new structures, NHS chief executive Sir David Nicholson has warned.

In a keynote speech at the National Association of Primary Care conference in Birmingham, Sir David said new commissioning consortia must tackle the 'tough decisions' if they are to successfully take forward the Government's reform agenda, including balancing the deployment of £1.5bn-worth of NHS managers.

Mr Nicholson was noticeably more positive about Andrew Lansley's healthcare reforms than in previous speeches, heaping praise on the secretary of state for his vision, and insisting that the timetable for implementation was achievable.

But he warned that consortia must tackle a series of crucial decisions before they can thrive, including deciding how many existing PCT staff to retain in their new organisations, and how many to dispense with.

He said: 'There are some tough decisions right now. If consortia decide to use services of none of the people in PCT, that leaves us with a bill of £1.5 billion pounds. The only place that can be paid from is the consortia allocation to consortia and PCTs. But if you take them all, it will cost nothing, but it won't deliver the change.

He said it was crucial that the best PCT managers were retained, adding: 'If we lose control of the system, you won't have the budgets to inherit.'

But he warned against replicating PCTs with new consortia, and said there additional big challenges ahead in ensuring the new arrangements were not just a 'GP's club', and in implementing a 'step-change' improvement the quality of primary care.

He also praised Mr Lansley for his long-term vision for the NHS, and said the white paper could be 'hugely beneficial' to patients.

He said: 'I've heard that a white paper has few friends. That's not the case. If we use it in the right way it can be hugely beneficial. We've got a wealth of experience and knowledge that we've never had before.'

Mr Nicholson said GPs should take their time over forming consortia, and not allow the leading edge to dominate their formation.

'Go slow in relation to building consortia,' he urged. 'That's not because I don't want them to move, but this is not a race. It's always important to have the leading edge, but we need to focus on building support.'

But despite this warning, he echoed comments made by NAPC chair Dr Johnny Marshall that two and a half years will be ample time for the reforms to take shape.

He said: 'We have two and a half years to make it a reality. The speed is remarkable, but you can do an awful lot in that time. If we don't make it in that window, the danger is the changes will run into the sand.'

'I think it's very scary, but we should have the confidence we can make it happen. The potential is absolutely fantastic.'