I applaud the Government's move to GP commissioning. Its white paper, though, makes interesting reading.
Section 5.17 states ‘a proportion of GP practice income should be linked to outcomes' – a so-called ‘quality premium'. It is proposed that this should be paid to the consortium, which would decide how to apportion it between member practices.
This introduces a form of performance management and competition between practices from within an individual consortium. An effective tool perhaps, but likely to create some volatility at the end-of-year share-out. Furthermore, it is stated that this premium would need to be funded from within existing resources. It is not a bonus but a reallocation of money currently being paid but without strings attached. The implication is a pay cut for some practices within consortiums, while better performing ones will supplement their income by taking cash from their less cost-effective members.
What ultimate sanctions would the NHS Commissioning Board have for persistent failure? It seems consortiums could be taken over or assigned to their neighbours.
This presents an interesting situation. Are we to assume the failed consortium members would forfeit their quality premium to the members of the successful takeover consortium?
Individual practices in that failed group could prove their worth in subsequent years and reclaim their premium. But a practice that continues to underperform would lose its contract and die. Frustrated members of the consortium might be more inclined to join the execution than was the case in the past.
This would be the basis of a hard-hitting, competitive primary care service. Elements would be empowering and stimulating – but there could be a lot of blood on the carpet.
From Dr Clive Henderson
Market Weighton, East Yorkshire
