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NHS Alliance calls for ‘dual-track’ introduction of GP commissioning

By Gareth Iacobucci

The NHS Alliance has called for a dual-track introduction of GP commissioning that would allow go-getting GPs to take on budgets as soon as possible, but give less accomplished commissioners more time to prepare for the transition.

In its response to the Government's consultation on its radical NHS white paper reforms, the Alliance called for ‘sufficient flexibility' in the rollout to accommodate ‘both fast movers and those that require a more considered timescale'.

It said debates over whether the mooted transition was too fast or too slow were an ‘oversimplification' of the current state of play, and said a two-tier introduction would enable the reforms to flourish as quickly as possible.

It said: ‘The reality that in some parts of the country putative GP commissioning consortia will be ready to assume responsibility for commissioning now and in the very near future, and in others, will require more development support and time to be in that position.

‘It will be absolutely necessary to manage the transition in an orderly way, and due regard must be given to the maintenance of PCT functions during this period (especially when budgets will be hard pressed), but a "one size fits all" approach will not maximise the opportunities.

‘This means that where consortia are ready, willing and able, they must be given full budgetary responsibility and the necessary management resource as soon as possible.'

The Alliance also called for the NHS Commissioning Board to be able to delegate the power to hold GP providers to account, but said the board should retain the responsibility for contractual performance, unlike the NAPC, which has called for consortia to hold practice contracts.

It also warned that the relationship between GP consortia and local authorities could become strained under the new system, and called for them to act as ‘mutual respecting partners'.

‘The values of partnership must not be replaced with adversarialism,' it warned.

The Alliance said it was vital not to throw the baby out with the bathwater by losing important skills within PCTs that would be crucial during the transition, and backed moves for PCTs to morph into social enterprises.

Michael Sobanja, chief executive, NHS Alliance, said: ‘The direction of travel is right. For years the NHS Alliance has been advocating that the balance of power for planning and delivery of health services should tip towards primary care clinicians, their patients and communities.'

He added: ‘There are many opportunities to improve the NHS and, as expected, there are also risks. Concerns around the details of implementation and timescale need to be carefully considered. The pace of change may be daunting but we must ensure we get it right. For that to happen, flexibility and a focus on culture, behaviour and outcomes, at all levels in the system, will be paramount.'