But Dr James Kingsland also outlined that the White Paper will not include detail on how accountability in commissioning will work.

Talking at the Nene Commissioning Conference in Kettering, Northamptonshire, this week, Dr Kingsland said unlike practice-based commissioning (PBC), GP commissioning will not be a voluntary process.

He said: ‘I don’t think we will see general practice having the ability to opt out. It will be able to have others managing the system for them, but not saying: "I’m sorry, I’m not going to be involved in that".'

He also said the White Paper will identify that a NHS Board with regional offices will be established.

He said the GPs will hold contracts with the regional offices, rather than with PCTs, and the regional offices will also be responsible for determining the funding for local GP consortia.

But Dr Kingsland added that health secretary Andrew Lansley wants to see the consortia identify individual practice budgets, to allow practices to ‘potentially do some work independently on behalf of their registered list’.

He said: ‘Just as in PBC, the vast majority of service re-design is going to have to be at scale.

'But that shouldn’t disallow a practice to say: "We think we can be more efficient for our registered population by expanding the primary care healthcare team by delivering a different type of care and possibly piloting some work which could be adopted more widely".’

Dr Kingsland added that the idea that GP commissioning is part of a patient-led NHS will be 'strongly articulated' in the White Paper.

He said: '[The White Paper] will clearly say that there is an expectation that patients will have elected positions on PCT boards, will have a strong voice in any local service delivery.'

But Dr Kingsland said how GPs will be held accountable if they overspend their budgets or fail on the productivity programme will not be included in the White Paper.

He said: ‘That will not be in the White Paper but that’s the detail which will be for the three months following the White Paper’s publication.

‘I don’t think we are going to see the accountable office position moved from PCTs yet, but there is going to have to be a discussion once GP commissioning is launched in the White Paper.’ 

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