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GPC moots plan for super-consortia covering millions of patients

By Ian Quinn

GP leaders have mooted the idea of forming SHA-size consortia, amid fears GPs will not be able to cope with the financial risk of the Government’s commissioning plans.

The new plan would see groups of GP consortia come together across entire regions, the size of strategic health authorities, making decisions on the care of ten times or more the widely floated figure of 500,000 patients.

The Government continues to insist it will not lay down any rules on the size and make-up of GP consortia, leaving the BMA to fill the information vacuum.

The idea of the super consortia is revealed in a new GPC guidance document for GPs, released today, which reflects growing fears that the financial burden which will fall on consortia, which currently stand to inherit huge debts from some PCTs, will mean only giant GP organisations will be geared up to cope.

However, the GPC admits that while the scale of the organisation would lead to a strong financial and negotiation base for GPs, it could risk adding more bureaucracy and leaving grassroots GPs detached from decision making, with consortia expected to appoint a lead consortia which could be based many miles from their patients.

But the report urges GPs looking to form consortia to beware of the potential financial risk faced by organisations that are too small.

It says small consortia, with only around 100,000 patients, could potentially provide a ‘direct and accountable link’ between practices and management but ‘may face difficulties in financial risk management.’

Such models would be ‘more susceptible to small variations in the commissioning budget’ it adds, warning that small consortia could find themselves in a weak negotiating position with large acute trusts.

On the other extreme, the idea of consortia across entire regions , would ‘commission services for a very large number of patients, potentially several million’ says the document.

It would mean consortia being ‘able to effectively manager financial risk’ and ‘provide a strong base for negotiations between acute trusts and consortia.’

However, the GPC admits the set up could lead to a ‘potentially complicated internal governance and accountability structure’ and ‘may add bureaucracy to decision making.’

‘Increased distance between the practices and lead consortia could reduce the sense of practice ownership of decisions.’

Another model would see consortia pool their management allowances to provide agency services for groups of consortia in areas such as human resources.

GPC negotiator and lead on commissioning, Dr Chaand Nagpaul , said: ‘There’s no doubt that given the extremely tight management budgets that we expect consortia will have to have a critical mass.’ The key to success will be combining the disadvantages of economies of scale to manage risk with given GPs a sense of locality ownership.’

GPC moots plan for super consortia, covering millions of patients