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We cannot operate in a vacuum

The involvement of non-GPs in commissioning services is looking increasingly likely, but how can consortia manage this shared responsibility, asks Dr Paul Zollinger-Read

Representation versus governance: these are two quite separate entities. Yet, I believe they are becoming confused in some of the anxiety generated by the Government's 'pause'.

The pause for those of you who are not aware is the colloquial term for the current listening exercise that the Government have begun. The NHS Future Forum led by Prof Steve Field, will take soundings from around the country, from different groups and individuals and feed these back, advising on what parts of the Bill we should proceed with and any areas that we ought to modify.

Since the announcement of the pause there has been quite a lot of 'chatter' on the GP wires about the governance of consortia and concern that non GPs will be taking on too much influence.

I think there area couple of important points to make here. Firstly let's not confuse governance with representation.

To govern an organisation is defined as, 'to effectively conduct the policy, actions, and affairs of an organisation'. The governing body can be composed of many differing individuals of different backgrounds, as you will find in many non-NHS organisations. Those individuals are there not because of their professional roles or any specific allegiance they have, but to use their skills and abilities to conduct the policy actions and affairs of that organisation. I have been involved in many NHS Boards where there have been excellent examples of local individuals from diverse backgrounds coming together to provide sound governance.

Representation is different; this is what we tried to do with PECs, prescribing individual places for particular professional disciplines or members of certain organisations; indeed we probably mixed and confused representation and governance and ended up with variable results. It is crucial we learn from PECs and ensure that governance for consortias is just that; individuals working to effectively conduct policy actions and affairs of the consortia.

Finally there has also been some angst about local politicians and their possible involvement in consortia. Having talked to many pathfinders I'm not certain this is so much of an issue. The feedback I have picked up is that it is crucial to develop these relationships.

Health cannot operate in a vacuum, it is so intrinsically tied in with the wider aspects of our patients lives that well developed relationships with local authorities are crucial. This is a steep learning curve but one that many developing consortia are already well advanced on.

Dr Paul Zollinger-Read is a GP and director of GP commissioning at NHS East of England

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