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GPs will lose cash if consortiums overspend

By Gareth Iacobucci

GP practices will lose a proportion of their existing income if commissioning consortiums overspend on their budgets, the Government has announced in a detailed document outlining how its plans for GP commissioning will work.

The consultation document - published today - recommends that ‘a proportion of GP practice income should be linked to the outcomes that practices achieve collaboratively through commissioning consortia and the effectiveness with which they manage NHS resources.'

Commissioning For Patients recommends that this ‘quality premium' - funded from within existing resources – should initially be paid to consortiums, who would then ‘be free to decide how best to apportion it between its member practices'.

The eagerly awaited document provides further details about how the Government plans to devolve the majority of commissioning budgets to GP consortiums, as part of the massive shake up of the NHS laid out in last week's health White Paper.

The Government says it expects consortiums to receive ‘a maximum management allowance to reflect the costs associated with commissioning' but does not stipulate what this is.

It says the remainder of a consortium's commissioning budget will be used ‘exclusively for commissioning care' - with practice income kept separate from commissioning income.

Under the plans, consortiums will not hold practice contracts - which will be held directly by NHS Board, but will be handed responsibility for managing contracts, which is likely to include the collection of benchmarking data on practice performance.

The document says practice-level budgets allocated to consortiums by the new NHS Commissioning Board will need to reflect ‘an appropriate share of healthcare resources' to include both registered and unregistered patients.

Practices will have a contractual duty for ‘efficient and effective use of local services', with each consortium expected to develop its own arrangements to ‘hold its constituent practices to account'. This could involve applying peer review to address ‘unwanted variations' in areas such as prescribing and management of long-term conditions.

The document also makes it clear that GPs will be able to hand their commissioning budgets over to the private sector if they do not wish to play an active role in commissioning in areas such as ‘analytical activity to profile and stratify healthcare needs, procurement of services, and contract monitoring'.

It says consortiums will have ‘the freedom to decide what commissioning activities they undertake for themselves and for what activities they choose to buy in support from external organisations, including local authorities, private and voluntary sector bodies.'

Practices will be granted the flexibility to form consortiums ‘in ways that they think will secure the best healthcare and health outcomes for their patients and locality', but consortiums will ‘need to be of sufficient size to manage financial risk effectively'.

BMA chair Dr Hamish Meldrum, said that while the document contained more detail about the government's plans, there was still 'many questions that need answering'.

He said: 'The proposals contain both opportunities and threats and we will be actively engaging with the consultation process to explore this in great detail and to ensure our members' views are taken on board. We will also be publishing our own proposals for how GP commissioning could be made to work.'

Commissioning For Patients

What GP consortia will be expected to do

• ‘Statutorialy' responsible for commissioning the great majority of NHS services
• Ensure the provision of comprehensive emergency services for any person in their area
• Drive up the quality of general practice through peer review
• Arrange for some of its GP practices to provide primary care services over and above those that they already have a duty to provide, subject to safeguards
• Promote innovations that improve both quality and productivity, whilst challenging any behaviours that are inappropriate both for good clinical care and for efficient use of NHS resources.
• Manage their combined budget and for deciding how best to use these resources to meet the healthcare needs of the patients for whom they are responsible
• Decide on a case-by-case basis whether to commission services themselves, or to make appropriate arrangements with another commissioning organisation
• Reduce health inequalities and ensure expenditure does not exceed their allocated resources

Source: Department of Health, Commissioning for Patients, July 2010

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