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What does the health bill mean for GPs?


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By Gareth Iacobucci

Health bill puts GPs in charge of commissioning, but the NHS board will hold them closely to account

GPs' freedom to lead NHS commissioning under the Health and Social Care Bill will be significantly tempered after the Government handed hefty powers to the NHS Commissioning Board. The board's powers to restructure or replace struggling consortia, and to withhold payments from those who miss budget targets, appear designed to calm nerves among those who see health secretary Andrew Lansley's reforms as financially risky.

Here, Pulse digests the key elements of the health bill and explains what they mean for GPs.

NHS board's powers

For all the talk of GP empowerment, the NHS Commissioning Board will be granted wide-ranging powers over consortia – including the ability to parachute in alternative commissioners to help run those deemed to be failing.

The board will be able to shut down consortia that have ‘failed to discharge any of [their] functions' or if ‘there is a significant risk a consortium will fail to do so'.

Every consortium will be required to prepare a plan at the start of each year for the board, setting out how it plans to hit health and financial targets.

These must also be agreed with new Health and Well-being Boards, giving local authorities and patients a key influence.

Size and structure of GP consortia

All GP practices will be required to be members of a consortium. The draft legislation affords GPs the flexibility to determine the size and character of consortia themselves, providing they cover the whole of England together, and do not coincide or overlap.

The only size specification is that consortia must be made up of two or more GP providers, meaning the four single-practice pathfinders will have to merge with others. But the board will be able to intervene to change the size of a consortium, bring in ‘any person who is a provider of medical services' to help run it, or remove any member of the consortium's management, if it is found to be failing.

Payments to consortia and practices

The board will be able to make payments at the end of each financial year to consortia that ‘perform well', by either improving health outcomes or saving money, and will have the power to make ‘one or more' advanced payments during the year. It will be able to withhold money at the end of the year if advanced payments are made but consortia fail to hit targets.

The bill contains provision for a proportion of practices' income to be tied to their consortium's ability to achieve outcomes and manage financial resources.

The ‘quality premium' is designed to reinforce GPs' legal duty to co-operate with consortium policy on cost-effective prescribing and referrals – with the consortium free to divide up money as it chooses.

Staff

The Government's impact assessment includes calculations for redundancy payouts, modelled on the possibility that 50%, 60% or 70% of PCT and SHA staff will transfer to consortia.

The assessment predicts the reduction in staff from the changes to reach 24,500 – 20,900 predicted redundancies and 3,600 through ‘natural wastage'.

Competition

The bill has introduced unfettered price competition into the NHS, with Monitor now responsible for ‘enforcing competition law' and ‘removing anti-competitive behaviour'. The legislation will force GP commissioners to open up services to any willing provider, including those from the voluntary and private sectors.

The extension of competition is the BMA's biggest concern, with its leaders warning the policy could destabilise local health economies and damage quality of care, especially if consortia are under pressure to make savings to stay within budget.

Timeframe

From 2011/12, all GP consortia must be established in shadow form, taking on increased responsibility from PCTs including leadership of the QIPP efficiency programme.

SHAs are expected to disappear by April 2012 and PCTs a year later, with GP consortia and the board formally established on a statutory basis, and consortia receiving indicative allocations.

From April 2013, GP consortia will become fully operational, holding real budgets and contracts with providers. The NHS Commissioning Board will have the power to delay full transfer of responsibility to GP consortia if GPs are not ready to assume full control.

In this circumstance, the bill gives the board power to manage commissioning activity directly beyond April 2013 or put management in place to do it.

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