The key to success

GPs, Primary Care Trusts (PCTs) and other stakeholders need to begin preparations now for a challenging new landscape for health service delivery and the less-than-sexy stuff of governance and probity is critical to future success. The NHS white paper for England, Equality and Excellence: Liberating the NHS, has promised to devolve power and responsibility for commissioning services to GPs working in consortia, replacing PCTs. Commissioning consortia will design effective care pathways for patients, which cross between GPs, local hospitals, local authorities and community-based nursing and therapies, like physiotherapy and podiatry. Consortia will determine local healthcare needs and services required to meet those needs. They will hold and ration cash budgets, enter into and manage the contracts for patient care with a range of providers of health and social care, including NHS acute trusts, GP-led providers, social enterprises and local authorities. Consortia will also receive a management allowance to fund the commissioning process – this will be less than that currently given to PCTs, since the policy aims to cut bureaucracy and reduce costs. A key negotiating point will be how much of this payment is linked to outcomes and performance. In theory, consortia will shadow PCTs until they are abolished in 2012-13, although some will begin sooner as PCTs disband earlier than expected. All GPs have a role to play in making these arrangements work, with a heavy responsibility to get it right. The formation, governance and management of consortia must be appropriate for the new responsibilities being granted and will be as important as scoping out health service requirements. A governance structure which makes decisions in line with consortium responsibilities and objectives, and on the basis of clear evidence, implements the decisions in a transparent way and operates internal controls to account for the use of resources, is essential. In particular, GPs must be alert to perceived conflicts of interest between their role as officers of a commissioning consortium and their membership of a provider organisation. Strong leadership and new skills sets will be required for GP consortia to be successful. The initial establishment of a consortium will require leadership and diplomacy to assemble the practices into a coherent grouping and obtain a mandate for the board to govern effectively. All practices in the area will need to be invited to join, regardless of past performance or relationships. Consortia will need to assemble a back-office support team to plan and manage commissioning. They will need public health advice, accurate and timely data analysis of expenditure, prescribing, referrals and clinical outcomes, budget and management accounting. Consortia are free to choose whether to employ existing PCT staff to do this or to contract out the service to external organisations. If transferring, they must allow for their responsibilities under the TUPE Regulations to honour the existing staff terms and conditions. Patients will judge at the point of delivery. GP consortia will only win plaudits if services have been commissioned effectively and continue to be managed better than currently. Mark Johnson is managing director of law firm TPP Law. A free report on preparing for GP commissioning is available here