The mass migration of PCT staff from trusts to consortia will be one of the make or break factors in the success – or failure – of GP commissioning. Alisdair Stirling looks at the challenges ahead
An estimated 15,000 staff will have new employers when PCTs are officially abolished on 31 March 2013. Many will already have been absorbed by the new NHS Commissioning Board, by local authority public health departments and by GP commissioning consortia. But a proportion will face redundancy and the tricky balancing act now facing consortia is how to ensure that the most talented and experienced staff in their local PCTs are not lost to the new NHS.
The BMA and other key organisations responding to the government's consultation on the white paper reforms – which closed last month – have warned of a potential loss of ‘corporate memory' in the transition. The worry is of a ‘brain drain', caused in part by the parlous financial state of many PCTs and the Government's drive to cut management costs by 45% over the next four years, which could mean new consortia having to operate on a shoestring and potentially beginning life understaffed.
The financial exigencies are real. NHS chief executive Sir David Nicholson told the NAPC conference last month that GP consortia face a bleak financial future unless they take on a proportion of PCT staff. The national cost of not taking on any of them would be £1.5bn in redundancy payments, which would have to come out of consortia allocations, he warned. If consortia were to take all current PCT staff on, it would cost the NHS nothing – but would not deliver the reforms the government wants.
At local level, fledgling consortia are not only grappling with working out which staff to retain, many are also entering new territory as employers, trying to come to terms with the different ways in which they can staff the new organisations and facing bewildering choices between using NHS staff and taking on new blood from outside the NHS – or even outsourcing to consultancies.
There is also the vexing question of TUPE – employment regulations that could apply to consortia under certain conditions and could potentially mean having to take on more staff than they need on their existing NHS terms and conditions.
A problem recognised
Confounding the staffing dilemma further for GP commissioners were two key messages given out from the centre at last month's NAPC conference – GPs should ‘go slow' in forming consortia, and there would be no further guidance from the centre on how consortia should be formed. It is also still not clear what current PCT responsibilities consortia will have to take on.
David Stout, director of the PCT Network at the NHS Confederation, said: ‘It's still a bit early for most consortia to be considering actual appointments. Even in places where they have a good fix on their boundaries and who their members are, they still haven't got to the bottom of what they'll be responsible for.
‘If you are in non-formal shadow consortium status, it's difficult to see what you do at the moment. The sheer level of uncertainty would make me worry about making decisions at this stage.'
‘Those going for pathfinder status will, as I understand it, get some resources and could begin talking to PCTs about how they might be staffed. They might get some way but they'll still be a long way from making formal appointments.'
‘The same goes for independent consultants. They're not yet in hiring mode either. I haven't picked up any news of staff leaving to join the private sector yet.'
He continued: ‘However, PCT staff are being made redundant over the next weeks and months and there is a real danger we'll be losing important skills. Also, we are losing capacity as PCT chief executives leave to join foundation trusts or other employers – these are not being replaced and the question is, are we already losing the wrong people?'
‘Another complicating factor at the moment is that PCTs still have to deliver their statutory responsibilities and perhaps can't afford to let staff go until there is an alternative means of fulfiling those responsibilities.'
NHS chief executive Sir David Nicholson, in an exclusive interview with Practical Commissioning, was asked what consortia can do to ensure the staff they need in the future are not lost over the coming months.
He said: ‘We will be publishing a Human Resources framework in November about how you can get to a place where practices/ consortia can start to identify people they want to work with over the next period and identify ways to make their positions more permanent. This will enable there to be some certainty over the process as we go forward.'
‘The worst thing that could happen would be to lose some of these excellent people in PCTs.'
The management allowance amount due to be announced in December's NHS Operating Framework should at least provide some information to build staffing structures around as consortia will know what staff they can afford to pay.
But big cultural barriers remain to be overcome by both PCT and consortia.
Sir David said: ‘PCTs and consortia are roped together, they're just going to have to learn there's mutual benefit in all of this.'
‘What PCTs want to do is ensure the successes and improvements they achieved will continue – their legacy if you like – and it's important that consortia understand that. Consortia will also have to work in a much less bureaucratic, much less controlling environment, so PCTs will have to learn to let go.'
Alisdair Stirling is a freelance journalist
Appointing staff? Information to look out for• DH's human resources framework is out this month, advising how staff can be secured while consortia are being set up.
• Management allowance figure in December's NHS Operating Framework.
• Guidance from law firms. Solicitors Mills and Reeve have already produced a HR framework for GPs in Cambridgeshire advising staffing options for consortia and the legal implications for each. Solicitors Andrew Lockhart-Mirams is producing a framework to cover many of the legal issues ahead. TPP Law has also produced a report, titled Preparing for GP commissioning.
• Pathfinder consortia and who they choose to employ.
