GP Commissioning - Can you carry on as normal?

Dr Jenner suggests simple steps GPs can take now to be ready for consortia and commissioning.

Dr Jenner: liaise with the LMC and other practices over the reforms (Photograph: Mike Alsford)
Dr Jenner: liaise with the LMC and other practices over the reforms (Photograph: Mike Alsford)

Since the publication of the White Paper in July and its four underpinning consultation documents, GP has given a lot of coverage to how the profession is deliberating over GP commissioning while practice-based commissioning (PBC) enthusiasts have encouraged everyone to get going without delay.

It is indeed a major policy experiment to make GPs publicly and legally accountable for commissioning the vast majority of NHS care.

Cynics would say: 'This is just another NHS reform; keep your head down and, like the previous half dozen, they will eventually move on to another, leaving general practice pretty much unscathed.'

However, I suggest that this reform looks different to others. This is mainly because it aims to make GPs legally responsible for a cash-limited budget for commissioning care, and will remove most of the NHS managers and organisations - with PCTs and SHAs to be abolished - that are accountable for doing that now.

It also potentially threatens the permanent nature of GP provider contracts if, as government minister Mark Simmonds threatened back in February when he was shadow Conservative health secretary: 'GPs who consistently fail to balance their books could risk losing their contracts'.

This was not confirmed in the White Paper or supporting documents but the devil is always in the detail and, so far, there is simply not enough detail to go on.

So what to do now
It is vital to remember that the consultation on the White Paper's supporting documents runs until 11 October and the necessary legislation is unlikely to be passed by parliament before next summer.

Any changes to the 2011/12 GMS and PMS contracts have yet to be negotiated so the question is how to prepare for what may happen. My advice is keep it simple.

First, identify someone, such as the practice manager, to liaise with other practices and the LMC over these reforms, and start thinking about how a future consortium might look.

Respond to the consultation via your LMC, the BMA or direct. However, do not assume it will all happen according to the current proposals: your views will count and this reform cannot happen without GPs' support.

Begin to look at your 'NHS resource footprint' - what you spend on referrals, admissions and prescribing and where you sit against local benchmarks.

Meanwhile, do not be distracted from providing excellent primary care now.

Be prepared for change. Identify trusted local sources and colleagues to keep you informed but do not feel the need to commit to anything just yet.

  • Dr Jenner is GMS/PMS lead for the NHS Alliance, a Devon GP and Mid Devon PBC Consortium chairman

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