By Nigel Praities
The GPC has issued the first detailed guidance to GPs on how to go about forming commissioning consortia, warning organisations covering fewer than 500,000 people risk going bust.
The Government has repeatedly refused to define the size of GP consortia - preferring instead to leave this up to local GPs. But new guidance issued today by the GPC (click here to read the full document) says individual consortia are likely to serve a population of between 100,000 and 750,000 people, reflecting 'the size of most large cities in England'.
But the guidance recommends smaller consortia do not take on all the responsibility for commissioning and should consider working with larger groups - or a 'lead consortium' - to ensure that they have the requisite clout to negotiate with acute care trusts and local authorities.
It also recommends consortia hold open meetings to ensure public accountability and that GPs avoid 'turf wars' with secondary care doctors by inviting them onto panels looking at service redesign.
It goes on to say that consortia must ensure they do not 'abuse' their new powerful position in the NHS and install adequate governance procedures to prevent conflicts of interest.
The guidance reads: 'All consortia should consider the benefits of working in partnership with their neighbouring groups, but where practices choose to form a consortium that is at the lower end of the suggested population range, they should consider joining with other consortia and either appoint a lead consortium for their federation, or develop a shared service agency that works on behalf of all members of the federation.'
'It is unlikely that consortia with populations of less than 500,000 will find it easy to manage financial risk, while they may not have sufficient management resources to function effectively nor take advantage of the economies of scale necessary to ensure that commissioning is efficient. Moreover, larger consortia (or a lead consortium) will find it easier to engage in credible interaction with acute care trusts and local authorities and to attract high calibre medical and managerial leaders.'
GPC deputy chair Dr Richard Vautrey said the current situation was still in flux, but that this guidance gave GPs the best advice about how to proceed with forming consortia.
'It's unlikely that the government will provide a lot of guidance about how consortia should be formed. GPs will be expected to organise it. This guidance is our view of how GPs should best proceed with making these arrangements. We will keep updating our guidance as more information becomes available.'
He added: 'The key thing to remember is that at a national level much is still to be decided and negotiated – we are, after all, still in the consultation period. Therefore any arrangements that GPs put in place should be flexible enough to deal with changes and nothing should be set in stone at this early stage.'GPC guidance What the document says
- Individual community-facing consortia are likely to serve a population in the range of 100,000 to 750,000 people
- Smaller groups may choose to subcontract some of the specific tasks to a lead consortium, or shared agency
- It may be appropriate to co-opt secondary care clinicians onto specific subgroups of the consortium when exploring service redesign
- Clinicians involved in the commissioning process should declare a conflict of interest where appropriate, and remove themselves from the process if this is too great
- Consortia may consider open commissioning meetings so members of the public can observe the work of the consortium
Read the full document:
GP consortia commissioning:
Initial observations, September 2010.
A top line-up of expert speakers – including Andrew Lansley, Sir David Nicholson and Mark Britnell - will be addressing the latest developments in GP commissioning at the NAPC Annual Conference in Birmingham in October.
To find out more and book your place today please click here.