Consortia are up to you, Lansley tells GPs

Andrew Lansley told the National Association of Primary Care conference that he expected GPs to propose the shapes and sizes of consortia. The only requirements are that they include more than one GP practice, have some kind of involvement with local authorities and are focused on patient outcomes. "The presumption is, the answer is yes," he told the event in Birmingham on 21 October 2010. The first wave of pathfinder consortia will be able to apply by the end of October and be in place by the new year, with more details to be published next week. The bill enabling the changes to primary care will also be published by the end of this year, which will spell out how powers will be transferred from primary care trusts to consortia. He said he spent six and a half years as shadow health secretary being told by GPs: "Why don't you listen to us? We can do it better." He added: "Now is your chance." Lansley said there will be no lessening of the pace in introducing GP commissioning, which will come into force in two and half years' time. "There are people in the audience who, if they were really pushed to it, could be ready in two and half months," he said. He conceded that some were nervous about how it would work. "I think the response from the profession has been enthusiasm, mixed with apprehension – wanting to do it, but wanting to know how to do it." He said that the time period would allow for research on the pathfinders to work out how consortia can succeed. His comments were reflected in an earlier speech by Dame Barbara Hakin, the NHS's managing director of commissioning development. "The commitment to making this happen is really strong and really absolute," she told the audience, save only that it is passed by Parliament. On the shape and size of GP commissioning consortia, she said: "You aren't going to get any more guidance. This is a permissive policy." It would be possible for consortia of varying sizes to exist, with smaller ones perhaps collaborating on some functions, she added. "We really need you to grasp this," Hakin, a former GP, added. "This is the biggest chance you've ever had. Please take it." Lansley said that the financial settlement announced on 20 October by chancellor George Osborne, which provides the English NHS with modest real term increases for the rest of this Parliament, does not protect the health service from having to make efficiency savings. The NHS chief executive Sir David Nicholson has said the service should save £15bn-£20bn from the NHS's annual £100bn bill. The difference between the NHS and other public services, Lansley added, was that "every penny that we now save... is available for reinvestment in the NHS". Increasing healthcare costs, as well as an ageing population, means that demand will increase by 3%-4% each year, and this will be funded by the efficiency savings. He added that other countries are also having to reconsider their health systems, and that the GP as gatekeeper to services, able to take responsibility for what is affordable for the community as well as the individual, is the best model. While acknowledging the excellence of France's healthcare, where patients can refer themselves to secondary care, he said: "They have very high levels of outcomes, very highs levels of satisfaction, but they are broke." He also said that telehealth and telemedicine will be among the techniques developed by £2bn of extra funding announced by the chancellor for the NHS and local authorities to be used for social care. Lansley suggested that many staff from primary care trusts, which are being abolished under the plans, could get jobs in the new consortia. "It's not the case that the abolition of primary care trusts will mean that all primary care trust staff will lose their jobs," he said. "I'm not intending to force you into (becoming) managers and accountants and the like," he told the GPs in the audience, adding that the consortia will get access to these people. But he stressed that GPs will have to lead the process of establishing consortia. "Many of my predecessors used to tell you what to do, and not understand what you were doing," he said, adding that he hoped to do the opposite in both cases. "I'm afraid it's up to you."