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These incredible cart-before-horse reforms

GPs need robust rules in place as soon as possible, to eradicate confusion, and ensure pathfinders are not only above board but seen to be so


There's a protocol to developing Government policy. First ideas are generated, generally through a mixture of advisory committees and political wonks, who play around with what might work and what might sell. Then, a hard-nosed team of senior politicians puts each proposal through the crucible, burning off those that will be too expensive, unpopular or blatantly unworkable. And finally, a hive of civil servants descends, prising apart the detail, tying down the vagaries and stamping out ideas that sounded good but won't work in practice.

At least, that's the theory. Yet health secretary Andrew Lansley has somehow sneaked some of his reforms into action without them yet having been approved by Parliament or even his Cabinet colleagues, and without the fine-print detail to withstand the scrutiny they are now getting. Take the regulations for the development of GP consortia – or rather, the utter lack of them. Pulse's investigation this week with the Bureau of Investigative Journalism reveals that at three of the first-wave consortia, at least half of board members have links with a single private company, Assura Medical. You might have expected such an eventuality would be covered in the regulations over how consortia should work, either to prevent it happening in the first place, or to devise a set of rules for how to cope with potential conflicts of interest. Pathfinder consortia are, after all, often far more than mere blueprints for the future – they are live bodies taking important decisions right now. But if you were expecting clear rules to be released before pathfinders were allowed to form, you would be reckoning without the extraordinary cart-before-horse nature of these reforms.

The Department of Health reacted with some embarrassment to our revelations. It admitted it is still to draw up a framework for the make-up and operation of pathfinder consortia, a full seven months after the first wave was launched. Instead, it is waiting for the results of its listening exercise before finally clarifying who will be able to sit on consortium boards, and whether their decisions will need to be approved by an outside body to avoid conflicts. Meanwhile, it is not only GPs who are trapped in limbo, unsure over how to proceed. A spokesperson for Assura conceded the company, too, was waiting upon the regulations, in order to learn whether the current arrangements will be allowable or not.

In some parts of the country, a large proportion of GP practices have signed up with Assura, forming jointly owned businesses operating a wide range of community-based services. It would probably be impossible to populate consortium boards in these areas without some Assura members. Even avoiding a majority with links to the company may be difficult, although if GPs want to steer clear of controversy and protect their reputations, they must surely do so.

GPs need robust rules in place as soon as possible, to eradicate confusion, and ensure pathfinders are not only above board but seen to be so. The profession should never have been left in this position. The Government failed to foresee the inevitable trouble ahead, and allowed pathfinder consortia to form without setting out even the barest details of the road they were expected to travel.

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