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Real commissioning budgets set to come with opt-out clause

By Susan McNulty

All GPs look set to get a commissioning budget but policy makers are understood to be considering an opt-out facility for those GPs who do not want the responsibility.

This would allow GPs to pass on responsibility to a third party such as a consortium or other practice but would ensure that all GPs are engaged with commissioning at some level.

Dr Shane Gordon, co-lead for the NHS Alliance's Clinical Commissioning Federation, said: ‘The noises that I'm hearing from the Department of Health indicate everybody will be allocated a budget and what we don't have is the detail about whether they will be able to block that back.

‘I'm sure there will have to be that level of compromise otherwise GPs will say "thanks, but no thanks" and there will be a battle with the BMA.'

Dr James Kingsland, PBC clinical network lead and NAPC president, said the days when GPs could say ‘I'm just a GP' were over.

‘Someone else has to manage the budget for them and that could be the consortium or their neighbouring practice. The idea that practices can just carry on or be a conscientious objector [to PBC] will no longer be possible.'

He added: ‘If a GP is saying they don't want to commission or be a budget-holder, then do they want to become someone's employee or have someone do it on their behalf?'

Dr Kingsland said the latter would still encourage peer review to tackle variations in referrals, which PBC had shown could work.

At a commissioning round-table meeting hosted by centre-right think tank 2020health earlier this month, Dr Kingsland said all GPs were commissioning already.

He told the meeting: ‘It's not a case of making it voluntary or mandatory but whether the GP is conscious or unconscious that they are making commissioning decisions.'

NHS Alliance chair Dr Mike Dixon said: ‘I think it has been decided that those who want hard budgets and can show an element of competence will be able to get them. Everyone will have a budget, whether a practice or PBC consortium. I hope there will be flexibility so you can have elements of the budget and not all of it.

‘I think it's very likely we will have a new GP contract so that commissioning is something all GPs do in some form so there is some effort to make sure prescribing and referrals are as cost-effective as they can be.

‘My reading is there will be flexibility but that has not been decided. I think there's going to be big change and nobody will be able to simply hide and hope it doesn't matter. Everyone will have to get engaged.'

NAPC chair Dr Johnny Marshall said the message he was getting was that the Government wanted all GPs involved: ‘Not everyone will want to be on the board, redesigning services or renegotiating contracts, but everyone will have accountability in the use of resources and that's consistent with the pre-election message.'

Dr Shane Gordon