GP pathfinder consortia: does size really matter?

The DoH named 52 pathfinder GP consortia in December, covering a quarter of the population of England.

Dr Mike Ingram: 'There are only three partners in our consortia and we all want the same thing for our patients' (Photograph: JH Lancy)
Dr Mike Ingram: 'There are only three partners in our consortia and we all want the same thing for our patients' (Photograph: JH Lancy)

The BMA has said consortia serving less than 500,000 people will struggle to manage financial risk, but the DoH has insisted that it will not dictate centrally how large the organisations should be.

As a result, the largest GP consortium, covering more than 600,000 patients, is almost 36 times larger than the smallest.

GP spoke to both ends of the spectrum to ask whether size was important.

View Map of GP pathfinder consortia in a full screen map

England's smallest consortium
Dr Mike Ingram, a partner at the Red House Group of practices in Hertfordshire, has formed the country's smallest consortium covering 18,900 patients across the group's three surgeries.

He admits that being small carries risks. 'If the local rugby club coach crashes and they all end up in intensive care, that would probably wipe out our budget,' he admits. 'But we have a proven track record as practice-based commissioners - we've already made big savings.'

As a small consortium, Dr Ingram is prepared to share certain functions with surrounding consortia, but he is reluctant to 'federate' into a larger network. 'Our patients are geographically isolated in a rural area of south Hertfordshire. Our GPs know our patients well and will be responsive to their needs,' he says.

He admits dealings between the consortium and hospitals will be on a tiny scale, but says close relationships between GPs, patients and consultants will ensure patients see the best doctor and get value for money.

Dr Ingram believes it is important for GPs within a consortium to be like-minded and have a 'common goal', which larger consortia may struggle with. 'There are only three partners and we all want the same thing for our patients,' he says.

England's largest consortium
As the largest pathfinder, the Oxfordshire commissioning group is made up of 83 practices covering 672,000 people.

Group chairman Dr John Galuszka said he did not realise other pathfinders would not cover similar populations. 'We spent a lot of time looking at the alternatives to having one large consortium.

'But we felt that because of the scale of the problems and because we had to deal with the largest secondary care provider in Oxford there are advantages to having a larger pathfinder.

'Our proposal is to have an Oxfordshire-wide consortium looking at the big commissioning decisions. It will be underpinned by strong locality arrangements to encourage GP practices to follow the ethos of the intended process.

'Getting involved in the pathfinder process at this stage will allow us to look at the model and refine it early so we can offer the best for our population.'

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