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Pathfinders merge to share risks and boost negotiating power

By Gareth Iacobucci

GP pathfinders have already started merging or federating together as they attempt to balance the need to stay in touch with grassroots practices with concerns over whether they are large enough to manage financial risk.

Leaders of early pathfinders plan to commission some services locally but will group with neighbours for larger-scale decisions and greater power when negotiating with foundation trusts.

It comes as the Government unveiled 40 third-wave pathfinders – and a Pulse analysis found many of those announced so far were far smaller than the BMA had advised for the purposes of coping with risk.

Only 6% of pathfinders to date are covering 500,000 or more patients – the BMA's magic number for stably managing risk – with one in five covering 100,000 patients or fewer.

The average consortium in the third wave contains 27 practices and covers 186,000 patients – similar to the second wave, but significantly smaller than the first.

Overall 177 pathfinders have now been announced, containing an average of 28 practices across 202,086 patients, and covering two-thirds of England.

But the Department of Health said some pathfinders from the second wave had merged after re-assessing their initial plans.

In Sheffield, Central Sheffield, Hallam and South, North Sheffield and West Sheffield consortia are now one federated pathfinder. The Cheltenham, Cleeve and Winchcombe PBC Consortium has joined the wider Gloucestershire group. And in Ashton, Leigh and Wigan, five consortia have formed one new pathfinder covering 62 practices and 373,740 patients.

Dr Tim Dalton, a GP in Wigan and chief executive of the ALPF Healthcare Commissioning Consortium, said the five would adopt a federated approach to retain the ‘subtle nuances' of local commissioning: ‘We wanted to make sure we tied it back to local practices. The fear is if we had just merged you are just replacing the PCT.'

Dr Dalton said services such as stroke and diabetes were being commissioned on a borough-wide basis, but others such as ENT and breathlessness more locally.

Paul Wike, primary care lead manager at Central Sheffield GP consortium, said his group would retain local autonomy when commissioning small-scale services such as gastroenterology and tele-dermatology, but, like Wigan, was working on a more federated basis for larger services.

‘We've got the biggest foundation trust outside of London, so we come together to negotiate,' he said.

Health secretary Andrew Lansley said the ‘varying shape and size' of pathfinders was evidence of a ‘truly bottom-up' approach.

But Dr Thomas Reichhelm, a GP in West Malling, Kent, said pathfinders were being ‘orchestrated' by PCTs: ‘I was hoping for real grassroots change with minimal bureaucracy. The more that comes out, the less likely that looks.'

Pathfinders in numbers

Fewer than 100,000 patients – 21% of pathfinders
Between 100,000-200,000 – 39%
Between 201,000-300,000 – 20%
Between 301,000-400,000 – 11%
Between 401,000-500,000 – 3%
More than 500,000 patients - 6%

Source: Pulse analysis of DH pathfinder data

Pathfinders merge to share risks and boost negotiating power

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