GP CONSORTIAGolden Opportunity or Poisoned Chalice?

Questions We Would All Like Answering

Why GPs? What are Consortia Expected to do? What will Consortia look like? What do GPs think of it? What do others think of it? How will GPs go about doing it? What support will they need?

The History of Change

1948NHS

Conceived

1974Grey Book

1993Fund holding

FHSA HA merge

1983Griffiths

1989Internal Market

1982Patients

First

PCGsPCTs

2010 GP Consortia

TCS

NHSPlan

Royal Commission

Key Pledges

First patients will be at the heart of everything we do

We will make the NHS more accountable to patients. We will free staff from excessive bureaucracy and top down control. We will increase in real terms spending on the health in every year of this Parliament.

Second there will be a relentless focus on clinical outcomes

Third we will empower health professionals. Doctors and nurses must be able to use their professional judgement

about what is right for patients

Health care will be run from the bottom up , with ownership and decision making in the hands of professionals and

patients.

Why?

Compared to other countries the NHS has achieved relatively poor outcomes in some areas: some respiratory disease Some cancers Stroke

Underlying risk factors need a focus from public health

Scores poorly on responsiveness to the patients it serves

Lacks a genuinely patient centred approach in which services are designed around individual needs

Why Professional Empowerment The GP as Gatekeeper Co-ordinator of care Every GP decision results in expenditure Nearest to patient – acts as patient

advocate History

GP Fundholding Primary Care Groups Practice Based Commissioning GP Consortia

Why the GP?

Gatekeeper role Ultimate initiator of health spend Makes GPs responsible for expenditure Contain ambitious consultant plans Cheaper in Community Better at achieving change More acceptable to public – GPs are

popular Clinically Driven GPs better at assessing Risk

Role of Commissioning Consortia

“The responsible commissioner” for any registered patients within constituent practices

Provision of comprehensive emergency services

Determining healthcare need Determining what services are required Managing contracts Monitoring & improving quality Oversight of providers training &

education plans

GPCC Duties

Stay within budget Equality & human rights Data protection & FOI Work in Partnership with LA Inform, engage and involve the public Develop its own arrangements to hold its

constituent practices to account

Criteria for establishment of GPCCs

“We do not propose to issue a Whitehall blueprint for the geography of consortia. We believe that GP practices should have the flexibility to form consortia in ways that they think will secure the best healthcare and health outcomes for their patients and locality.” Commissioning consultation document para 4.5 “It is the job of the centre to set clear expectations of GP Consortia and to ensure they have the capability to meet those expectations – but not to design or enforce their size, geographical coverage or precise management arrangements.”Letter from Sir David Nicholson to Chief Execs 13th July 2010

Fundamental Requirements

Universal Coverage – interlocking boundaries

Every GP needs to be a member of a consortium

Sufficient geographic focus to be able to agree and monitor contracts such as urgent care

Sufficient size to manage financial risk

Timescales

2010/11

2011/12

2012/13

April 2013

GP consortia begin to come together in shadow form

Shadow consortia in place

Establishment of consortia with indicative allocations. Preparation of commissioning plans Fully

operational with real budgets

Large Option

Population about 500,000Approx 250 GPsBudget about £500mManagement allowance approx £5mSupport staff around 100

Small Option

4 localities of around 120,000Around 60 GPsBudget approx £125mManagement allowance around £1.2mStaffing support of about 20

Making it work

Large consortium with sub localities Devolved budgets Management tiers Locality

committees Can pay “big

salaries”

Small consortia acting collectively•Lead commissioning / speciality leads•Collaborative commissioning•Single tier of management•Shared posts (eg finance)

What has the LMC Done?

Roadshows in each locality Response to DOH consultation Established GP Consortia Steering Group

to oversee process of designating Consortia Must be GP led Must have democratic mandate Needs to be inclusive of all GPs

Facilitating further debate / information with PCT support to enable informed choice by GPs

But will the GPs Buy into it?

Ambivalence Poisoned Chalice Golden Opportunity Conflict - Individual / Collective New accountabilities Worries about privatisation Time to do it

What Do Others Think?

PCT staff demoralised and leaving Everyone is a GPs friend now Existing GP leaders wanting to maintain

power and influence Ordinary GPs just wanting to do the day job Consultants feeling marginalised Nurses wondering where they fit Unions opposed to change and sceptical Third Sector worried

Pathfinder Consortia

Rolling Programme 6 in North West in first wave Within existing PBC rules Must show GP engagement / support LA involvement / support Track record of success in handling

devolved budgets and delivering QIPP Not definitive for future No extra funding

Getting Themselves Organised Stakeholder Groups Executive Groups – by election Consider governance arrangements Federated Working Links with Public Health, & Patients Working with Health & Wellbeing Board &

Health Watch Links with Hospital Consultants Seconded Staff and building the new

team

PCT

Consortium

• Delegation as PCT Sub Committee• Hand Holding• Letting Go

Dangers

The Economy Public hear the wrong message Privatisation debate derails it Too many hostile groups Treasury caution Professional cynicism Lack of freedoms promised will lead to

GPs becoming disillusioned BMA