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The White Paper – first steps



As GPs and managers across the NHS get to grips with the impact of the white paper, Dr Judith Smith considers the state of play in the development of new GP commissioning consortia

The publication of the white paper Equity and Excellence: Liberating the NHS has come as something of a seismic shock to the NHS. While hard budgets for GP commissioning together with a national commissioning board had been effectively trailed in advance of the white paper, the wholesale removal of PCTs and a new role for local authorities in commissioning were unexpected, and have made the changes appear both radical and risky.

The NHS is, however, well accustomed to responding to policy proposals that appear at first sight to be capable of rocking it to its foundations.

In this edition, a selection of GPs and managers across the NHS share how they are starting to plan the development of new GP commissioning consortia. What is clear is that they are focused on ensuring consortia are formed in a way that makes sense for the GPs who will have to collaborate in taking on new responsibilities, and enables sufficient scale for carrying financial risk and putting in place adequate management infrastructure.

Along with understandable concern at the scale of the task ahead and a desire for more detail about budget-setting and other critical issues, one can sense the excitement and energy felt by some of these emerging GP commissioning leaders, who are clearly committed to seizing the opportunities presented by the white paper proposals.

While GPs and managers await further Department of Health guidance, national bodies are not wasting any time in setting out what they think nascent GP commissioning consortia should be doing.

Both the RCGP and the GPC have issued guidance for GP commissioning consortia in recent weeks, much of which echoes analysis previously published by the Nuffield Trust on behalf of a range of national organisations, Giving GPs budgets for commissioning: what needs to be done?

The recent GPC guidance is looked at, including its recommendations about the importance of a large geographical scale for commissioning (500,000 patients being suggested as desirable), the potential role of the LMC as ‘midwife’ for the changes, and the need for careful consultation about how practices join or are admitted to consortia.

The white paper changes are not, however, confined to GP commissioning, and one of the major aftershocks of the overall set of proposals comes when one examines the potential new role for local authorities in respect of health commissioning.

What’s been proposed is examined in another piece pondering the powers that local Health and Wellbeing boards, public health departments within councils, and HealthWatch (the proposed new patient advocacy bodies) might be given and what this might mean for GP commissioners.

What is for sure is that the seismic activity will calm down as the process of white paper implementation moves forward, and the details of making things happen start to consume huge amounts of managerial and clinical time.

What is not so certain is the extent to which damage caused by the process of change, especially in relation to the loss of PCT commissioning capacity and capability, will be mended in time for GP commissioners to take up their new roles and start to deliver solutions that can address the financial and service challenges facing the NHS.

Dr Judith Smith is head of policy for the Nuffield Trust

The white paper: first steps