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Andrew Lockhart-Mirams: More flexibility for consortiums than originally thought

It seems a considerable level of local variation will be allowed

Although the Government's proposals for commissioning are out for consultation it appears that the NHS Commissioning Board is going to allow a wider degree of flexibility amongst consortia than had originally been thought.

Clearly there will be a number of essential elements that will be required and model contract documentation prepared by the Board will certainly include areas such as financial probity and accountability, reporting and audit.

It is probable that the financial probity and accountability requirements will be very similar to those presently imposed on PCTs. Reporting will require a commissioning plan and a report on expenditure.

What the audit requirement will be, has not been stated but it is probable that audit arrangements will be carried out by the District Auditor, although there may be scope for accountancy firms to do some of this work.

Outside these basic requirements it appears that considerable level of local variation will be allowed and model contracts can be adapted to allow commissioners to include quality marks, allowing them to judge what will produce the best outcomes for patients.

Whilst consortia will not be able to provide services in their own right, it is clear that individual practices or groups of practices are to have the opportunity to provide new services (in addition to the primary care services they will be required to provide under their main contract) where this will provide best value in terms of quality and cost. Model contracts will, however, need to contain appropriate provisions to guard against real or perceived contracts of interest between members of the consortia and individual practices or groups.

Undoubtedly, there will be a wide range of practices within each consortium and the consultation paper notes that if an individual practice is causing ineffective or wasteful use of NHS resources the consortium would be expected to work with that practice to address the relevant issues. If this did not succeed at the end of the day the NHS Commissioning Board would need to be involved.

Andrew Lockhart-Mirams is a specialist contract lawyer

Andrew Lockhart-Mirams