By Ian Quinn
Exclusive: Lawyers have revealed GP consortiums will be responsible for setting terms and conditions for local practices, amid claims a model contract is needed to avoid complete chaos.
There is huge confusion about how the Government's plans to transfer the vast majority of commissioning responsibility to consortiums of GPs will work in practice and how the spoils of incentives will be divided up.
Lawyers have been told that while the new NHS Commissioning Board will set nationwide demands for GP consortiums, many of the most controversial decisions will be left down to GPs thrashing out complicated contractual agreements with their fellow practices.
This is expected to be a huge legal minefield which could pit practices against each other, with massive issues, such as which practices have the most control over referral issues, left to local negotiations.
Just yesterday Mr Lansley told the Commons he expected GPs in consortiums to police their peers, such as struggling single handed practices, to ensure proper accountability and quality.
In London, where up to 100 consortiums are expected to be formed, Londonwide LMCs have employed leading law firm Lockhart's in a bid to draw up a model contract, which the company hopes could be taken up nationally.
Andrew Lockhart-Mirams, senior partner at the company, told Pulse he expected massive ructions between different groups of GPs and warned that the task of GPs policing each other would prove one of many huge pitfalls facing the Government's plans.
‘It makes it clear in the White Paper that there is scope for local variation,' he said. ‘20-30% of the terms for GPs commissioning we think will be decided locally.
‘What to do with poorly performing practices is going to be a huge issue.
'In one consortium you're going to have four of five practices at the top who are now going to have to work with the four of five at the bottom who have been the thorn in the side of the PCT for years because they've got poor premises, poor data, poor people skills and don't give a fig about commissioning. There a huge job to reconcile the two.'
He also said the division of responsiblity and incentives promised by the Government for those who achieve health benefits or financial savings would be crucial.
‘Smaller practices will be demanding they get a fair share of the money but then big practices with thousands of patients will be saying they should get a bigger share.'
‘I don't really think the Government realises the issues that are involved with this,' he added.
Dr Michelle Drage, chief executive of Londonwide LMCs, urged practices to accept their offer of legal support and against making rash decisions because of pressure from ‘over-enthusiastic GPs', trusts or private firms.
‘Hold on to what you have got and don't be seduced or bullied into giving things away,' she added, saying it was vital all practices had a proper chance to influence the development of their consortium.
But Dr Drage added that there were also ‘significant opportunities for GPs, warning that ‘non-engagement will only service to promote the interests of the commercial sector and predatory foundation trusts.'
Health secretary Andrew Lansley is due to release a major consultation document over his plans for GP commissioning, including proposals to make it a responsibility for every GP and a raft of tough new accountability measures, plus incentives, in the next few days.Dr Michelle Drage: GPs mustn't allow themselves to be bullied by other practices Dr Michelle Drage: GPs mustn't allow themselves to be bullied by other practices Click here to read all the latest news and views about the health White Paper Health White Paper