GP CONSORTIA Golden Opportunity or Poisoned Chalice?
Apr 01, 2015
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