New dawn for commissioning as GPs start taking hold of budgets

By Ian Quinn, Gareth Iacobucci

Exclusive: Practices across England are starting to take responsibility for their share of £80bn of NHS budget ahead of crucial negotiations over how commissioning will be written into GP contracts, a Pulse investigation reveals.

Spearheaded by the most advanced practice-based commissioning groups, many GPs have acted quickly to draw up transition plans with NHS managers, following health secretary Andrew Lansley's announcement that PCTs are to be scrapped by April 2013.

However, vast differences are emerging between the pace of change in different areas, and the enthusiasm with which NHS managers are pushing ahead with the ambitious plans.

Some trusts have already begun handing over commissioning budgets to groups of GPs, and are replacing existing PEC structures with much more powerful GP bodies.

In these areas it appears GP consortiums will be up and running in shadow form as early as next year, and will have fully fledged responsibility long before the Government's April 2013 deadline.

But others have yet to act at all, saying they will not move until negotiations between GP leaders and the Government conclude and full details of plans for consortiums are published.

A recent Pulse survey of GPs, conducted shortly after the release of the health white paper, found that a quarter had already entered talks with their PCT on increasing their commissioning responsibilities.

But that process now appears to be gathering pace. Of 29 trusts to respond to questions last week, 23 said they have already begun the process of handing over decision-making power to GPs, although some have gone much further than others.

In Cumbria, six GP-led boards are directly managing a share of the county's annual £850 million health budget, with each locality board responsible for commissioning hospital, nursing and other services.

In a departure from the traditional PEC structure, the six lead GPs from each locality board now meet in a group known as the clinical senate, which holds decision-making power over the whole county's health economy and signs off on large-scale commissioning decisions.

In Trafford, Greater Manchester, GP leaders said commissioning plans are advancing at pace. Dr Ravi Mene, secretary of Salford and Trafford LMC, told Pulse: ‘Discussions over transfer of power are taking place at the moment. We have a unified consortium of all Trafford GPs, working with the local District General Hospital in providing services and taking control of the budget.'

Elsewhere, NHS Manchester and NHS Sefton both hope to establish a shadow form of GP commissioning during 2011.

But some trusts, including NHS Richmond and Shropshire County PCT, said they had no concrete plans in place to consult with GP commissioners.

And in other areas, NHS managers claim that a gulf in data and commissioning backup means GPs cannot survive without them, and they are pushing ahead with plans for so-called joint working models.

NHS Oxfordshire said there was an ‘acknowledgement amongst the Oxfordshire GPs that support services will be required to commission services effectively'.

In London, some trusts are pressing ahead with plans to introduce shared-service models through polysystems, despite Mr Lansley calling a halt to NHS London's capital-wide restructure.

NHS Waltham Forest claimed its hub-and-spoke model, with a series of polysystems governed by a GP-led board, gave ‘each practice a seat at the table' and would enable it to become an early adopter of the plans. The trust has appointed 11 GP clinical leads, one for each of our health priorities, such as cancer and cardiovascular disease.

But GP leaders have warned practices not to sign up to plans too hastily, particularly those which effectively replace PCTs with new manager-run organisations.

GPC chair Dr Laurence Buckman said the GPC was aware that although ‘many PCTs are pushing ahead trying to make arrangements', he 'would urge GPs to resist pressure to move too quickly'.

But NAPC chief executive Mike Ramsden advised GP commissioners to ‘start identifying those with whom you know you are able to work, whether from PCTs or elsewhere'.

He said: ‘Remember – early adopters will be established in the next financial year so there is a lot of preparatory work which should be undertaken now. Do not be deterred from your mission.'