Commissioning participation 'may need to be tiered'

The DoH may need to enable several 'tiers of participation' in commissioning to reflect the fact that many GPs are not keen to take part, a report says.

The report, jointly published by the RCGP, the National Association of Primary Care (NAPC), NHS Alliance, the NHS Confederation’s PCT Network, the Nuffield Trust and the King’s Fund, warns of ‘significant’ challenges in trying to engage more than an ‘enthusiastic minority’ of GPs in commissioning.

It highlighted that a ‘key decision’ for policy-makers will be whether to make commissioning mandatory.

A single-model, mandatory system could be problematic, the report says, and instead policy makers should consider ‘tiers of participation’.

This would include a full risk-bearing group, a partial risk-bearing group and a provider-only primary care option for those who do not want to commission services.

‘Options should be explored whereby GPs might take responsibility for commissioning – perhaps through their contract – but could choose not to do it themselves,’ the report says.

Allowing GPs to enhance their income by keeping savings made by commissioning could encourage doctors to engage, the report adds.

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