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DH administers last rites to independent-contractor model

By Richard Hoey

Not only will GP consortiums be responsible for huge swathes of the NHS budget, but they will also get major powers over individual practices, says Pulse editor By Richard Hoey


You may well have gained the impression from previews of the health White Paper that it would outline the biggest shake-up of the NHS since its inception, more than 60 years ago.

But in fact, it's so much more than that.

OK, so there's lots in the White Paper that we had already reported, during what has been a frantic month of whispering and leaks.

We knew that GP practices would be made to join a federation, or consortium, in the document's terminology.

We knew GP consortiums would be contracted directly by the NHS Commissioning Board, and would take over the vast majority of PCTs' commissioning (and budgetary) responsibilities.

And we knew too that GPs were set to have those commissioning responsibilities written into their contracts, at least in England – the days of a UK-wide contract do appear to be over.

But these individual pieces of information hadn't captured quite how dramatic and far-reaching the planned reforms are. Quite simply, this White Paper spells the end of the GP practice as an independent entity.

The global sum formula is to be rewritten, and to include weighting for the number of registered patients from deprived areas, which in itself is a substantial reform.

But on top of this comes a commissioning allocation for each practice, with the actual cash to be pooled together to form the GP consortium's combined commissioning budget.

And with this cash budget comes significant new powers. Practices will be contracted to the consortium and answerable to it, at least as tightly as they are now held to account by PCTs, and possibly more so. After all, the consortium now has a direct financial stake in the performance of its GPs.

The White Paper plans are undoubtedly exciting for general practice, if nerve-wrackingly so.

GPs are to be handed huge, unprecedented powers over the NHS.

Amidst the wreckage of the financial crisis, they are among the few public sector workers who could, if they commission effectively, gain rich rewards. The document talks of ‘powerful incentives' for those who meet their commissioning targets.

But there are also giant risks. Those that go to the wall will not be bailed out – the document makes that chillingly clear.

And beyond that, there is a greater risk still.

In this brave new world, in which the rules of the NHS, and the balance of power between doctors and managers, are fundamentally redrawn, there is a risk that something could be lost.

Could that something be the cherished independent-contractor model of general practice?

By Richard Hoey, Pulse editor