‘Here’s our new song, just like the last one.’ A lyric designed to satirise the music industry could just as well apply to performance management in the new world of general practice.
Certainly, any hopes that practices were to be released from red tape and Big Brother scrutiny are looking increasingly vain. This week, we learn that those discredited tunes of the old PCTs – QOF crackdowns, balanced scorecards and performance reviews – are all set to be revived by GP consortia.
The Department of Health has revealed consortia will have a legal duty to scrutinise practices’ performance, with a particular remit to monitor, and act upon, any perceived discrepancies in QOF achievement. That follows an Audit Commission report focusing on a long-term DH bugbear – the wide variation between practices and PCTs in rates of exception reporting. Indeed, it looks like consortia will come much closer to managing practice contracts than most GPs will find comfortable, with the GPC predicting they will replicate PCTs’ ‘performance management units’.
Before the health bill was announced, there was a fierce debate between different GP organisations about whether consortia should hold practice contracts. Under the health bill, they do not, but that distinction seems to lose its significance in light of the new information from the DH. ‘If any contractual issues arose, they would then need to report them to the board,’ a spokesperson told Pulse. Note the word need. Consortia will not only have to manage their practices’ performance as a means of hitting their quality premium – they will be held directly and legally responsible for their ability to do so, by the powerful and increasingly ominous-looking board.
So, it looks likely practices will be thrust into just the kind of exhausting war of attrition with consortia that many have experienced for years with PCTs. But does that make consortia simply a £1.45bn reinvention of the PCT wheel, with a few GP leaders chucked in to justify the claims that power is being shifted to the front line? Not quite, because while they may have comparable powers to scrutinise, berate and threaten GP practices, consortia will be far less powerful than PCTs in their ability to reshape other parts of primary care.
Take another key development of the week – the announcement of a DH review into the future of Darzi centres. GP consortia will, apparently, be able to decide the fate of the walk-in element of Darzi centres’ work, since this fits within their remit for urgent care. But the decision over whether Darzi centres should be allowed to continue to provide registered care to patients is out of their hands, since this is classed as primary care, and as such is under the auspices of, yes, the NHS Commissioning Board.
GP consortia risk being the public face of commissioning decisions, without the power to change the bigger picture. Practices will have their freedoms constrained, but this time not by managers, but by their colleagues down the road. Not quite the same song, perhaps, but the Government once again has GPs dancing to its beat.