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Get under the bonnet right now

The success of GP commissioning relies on consortia getting to grips with PCT debt early on, says Dr Paul Zollinger-Read.

If you haven't yet read the GPC guide on the structure and form of GP consortia issued last week check it out; very sensible, well thought through paper.

Consortia development is moving at a pace, but there's one important issue that I don't think has been fully debated yet: and no it's not deficits; (however I will comeback to that before I finish); its workforce. I may be alone here, but I don't think we can deliver clinically-led commissioning on a few GPs doing the odd session here and there. Each consortia will need a ‘hard core' of GPs who will be hybrids, able to coexist in both the GP world and the dark side of commissioning management.

True, the majority of GPs will carry on being exactly who they are at the moment, but without this hybrid group progress will be problematic.

How do we ensure these leaders are in sustainable roles? Not just giving them the tools to do the job but also the time. Relying on locums won't work; the inevitable phone call that the locum hasn't turned up will not be far away.

Also, what about GP training? Surely we need to recognise the new world we are entering into? These issues have not been high on our to-do lists up to now, but we now need to ensure they are raised to the top as success depends upon them.

Now back to the debt issue. There's been a lot of debate about should or shouldn't consortia inherit deficits; indeed I believe Pulse is starting a campaign along these very lines. As someone who's spent the past six years taking on organisations with debt this is I believe somewhat of a red herring; indeed may I be as bold as to say a distraction.

Debt is rarely a one-off issue and is usually due to some recurrent structural issue within that health economy. Determining the causes (as they are usually several) and ‘chasing them down' is the crucial issue.

If these issues are not flushed out, deeply understood and rigorously addressed consortia may well resort to non recurrent solutions which will only lead to more pain further down the lines.

So consortia need to lift the bonnet on debt, dig deep and work out what are the recurrent solutions. These issues can't wait and I'd strongly advise developing consortia in areas with debt to get under the bonnet right now.

Dr Paul Zollinger-Read is a GP and chief executive of NHS Cambridgeshire

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Dr Paul Zollinger-Read