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Call for consortia to crack down on ‘unwarranted’ GP variation

By Gareth Iacobucci

GP consortia should publish data on individual GPs’ clinical decisions in order to ramp up standards in their colleagues’ performance, says the NHS Alliance.

In its response to the Government’s consultation on its NHS White paper, the Alliance’s GP Commissioning Federation says consortia should not be afraid to use leverage if peer-to-peer scrutiny uncovers ‘unexplainable and unwarranted’ variation.

It says this scrutiny could include requirements to ‘share patient level data and data about individual clinician’s behaviour’ including referral rates to particular specialties.

Health secretary Andrew Lansley has made clear that GP consortia will be expected to closely police struggling peers to ensure proper accountability under his radical overhaul of the NHS.

The Federation said the balance between ‘incentives and sanctions’ should be determined locally under the new regime, and negotiated within any new GP contract to ensure member practices are ‘fully committed’ to their consortium.

The response also calls for consortia to operate an ‘open book’ accounting policy to allow external scrutiny of their commissioning decisions, and head off accusations of conflict of interest.

It says consortia should ensure they develop: ‘a clear conflicts of interest policy, including declarations of interest in provision, [and] open-book accounting regarding investment in services.’

It also calls for consortia to be allowed to develop a new menu of enhanced services to directly offer to member practices, as long as they are independently agreed by the new NHS Commissioning Board.

The feedback to the consultation has been published separately to the Alliance’s official response, which called for a dual-track introduction of GP commissioning that would allow advanced GP commissioners to take on budgets as soon as possible, but give less accomplished groups more time to prepare for the transition.

Dr Amit Bhargava, GP in Crawley, West Sussex, and co-lead of the GP Commissioning Federation, added: ‘GP commissioning consortia will give us the opportunity to shift the power back to clinicians and their local communities. But it won’t be the same for everyone, as we are all at different stages of the learning path.

Julie Wood, director, GP Commissioning Federation, said: ‘GP commissioning consortia are definitely the way forward. But we also recognise that, if we are to truly reap the benefits of clinically-driven commissioning, we will need to make significant changes – not only to systems and processes that support GP commissioning but also, fundamentally, to the behaviours and cultures that run through the NHS for both commissioners and providers.’

Outpatient referrals should be scrutinised by consortia, says the NHS Alliance Take a pioneering role in the restructure of primary care

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