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The biggest challenge in the white paper



In his latest note from the dark side, Dr Paul Zollinger-Read explores the minefield of GP relationships with local authorities – can these ever be navigated safely?


The white paper has set us a very clear and compelling vision, but the script in many areas has yet to be written.

It is a curious that we find this difficult to cope with, as for me this is one of the strengths of the white paper. It allows for local debate and flexibility and can deliver sustainability.

One area that needs to be centre stage – and one that will be the most challenging – is the crucial issue of the relationship between GP commissioners and local authorities.

The white Paper is clear that local authorities will have a central role working with GP commissioning groups, particularly in areas such as joint commissioning for elderly care and children’s services, using vehicles such as pooled budgets.

Local authorities will be responsible for local needs assessments and they will also manage public health teams.

The White Paper talks about ‘health and wellbeing boards’ comprised of GP leaders as well as members from local authorities. These will be responsible for discharging many of the above functions.

The relationship between GPs and local authorities are some of the more complex areas that we currently manage – with some working with both county councils and district councils

It is an area of significant risk, both in terms service risk (such as safeguarding) but also financial risk (particularly as social care budgets come under more and more pressure).

It is also one of the areas that has significant potential if we can really develop joint commissioning, using pooled budgets to their full potential and implementing ideas such as ‘local place’ budgets.

This is where we identify all the public sector funds going into one area and use them in a pooled fashion to ensure the greatest overall benefit; rather than lots of small ring-fenced pots of money for health and social care.

Many areas have developed good working relationships, but not all, so this needs to be high up the to-do list for developing GP consortiums.

This area requires a great deal of thought and we need to start looking at how to make this work.

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

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Dr Paul Zollinger-Read