By Gareth Iacobucci
Exclusive: GP pathfinders are taking vastly different approaches to spearheading the Government's health reforms, with some following an NHS-only policy in recruiting commissioning support, while others plan to outsource almost every element to the private and voluntary sectors.
A Pulse investigation into the commissioning plans of 25 of the most advanced pathfinders finds the Government's promise of a bottom-up approach is becoming reality, but so are the risks of commercialisation and postcode lotteries.
Some pathfinders are even setting themselves up as private companies until the formal handover from PCTs, although the Department of Health told Pulse consortia would not be allowed to be companies when they became statutory NHS bodies in April 2013.
But the survey reveals the private sector is likely to play a greater role in the NHS than ever before, with three path-finders planning to use external support in six or more areas of commissioning, including accountancy, tendering, contracting and referral management.
In contrast, some are open in their intention to keep the private sector ‘at arm's length', with six of the 25 planning to use only NHS managers across the seven areas of commissioning support we asked about.
Almost a third said they were planning to enlist external support to help with referral management, suggesting the private sector's involvement will not be limited to non-clinical areas. Half said they planned to enlist external support for human resources, 29% for accounting, 29% for data analysis and 29% for back-office support. Overall, 11 of 25 are talking to private-sector or voluntary-sector organisations about commissioning support, and seven have signed deals.
The Newcastle Bridges GP Commissioning Consortium was among six groups planning to use only NHS managers. Its chair Dr Guy Pilkington told Pulse: ‘For any management support we're looking to NHS staff. There is an organisational memory we must not lose.'
But South Birmingham Independent Consortium said it planned to seek external commissioning support across six areas including contracting, data analysis, human resources and back-office functions.
Dr Peter Patel, chair of SBIC, said local consortia would enlist commissioning support from external sources on a federated basis, to reduce financial risks and aid efficiency: ‘The existing NHS structure is an old model which is inefficient. We need to take a reality check.'
Just over half of pathfinders said they were on course to break even under current commissioning systems, with a quarter at risk of falling into deficit without some structural change and 20% in severe deficit requiring major change.
Over 90% have already issued guidance to member practices on areas such as efficiency savings. Eleven pathfinders said they were prioritising urgent care, while 10 were prioritising referrals and six are focusing on shifting care out of hospital.
East Suffolk Federation and Hunts Health in Cambridgeshire are set up as private companies, with ESyDoc in Surrey set to follow suit. Leodis in Leeds is a Limited Liability Partnership, while HealthEast in Norfolk and South Manchester are social enterprises.
A DH spokesperson said: ‘The point at which consortia that are private companies or any other set-up will have to cease being so will be when they become a statutory NHS body.'
Dr Puvana Rajakulendran, a GP in Earls Court and member of the Kensington & Chelsea GP Commissioning Consortium, said: ‘Up until 2013, it's almost like a pilot. People can be very creative. But at the end of that, I'm not sure you're going to be so free to do what you want.'Dr Puvava Rajakulendran Pulse pathfinder survey Full results