Chris Lancelot: Consortia will need iron fist to keep discipline

A chain is only as strong as its weakest link, and, for consortia, the weakest link will be less-capable practices. No matter how dedicated the rest, a handful of incompetent, lazy or politically disaffected practices will foul up a consortium's entire operation.

The GP Record, by Fran Orford

Given the notorious independent mindedness of GPs, how will consortia monitor and control their practices?

Will consortia be able to jettison practices that don't achieve the consortium's objectives? If not, what will they legally be entitled to do to discipline them? Fine them? Disbar them from receiving grants, pump-priming money, bonus payments or management fees? What legal constraints will be put in place to ensure fair play, both over the assessment and monitoring of practice effort, and in relation to any disciplinary action?

Who will issue the practice contract - the NHS Commissioning Board or the consortium? If it is the Commissioning Board, all practices will have to submit large amounts of data to justify the continuation of their contracts - bureaucracy and data collection that we had all hoped would disappear under the White Paper's proposals. Conversely, if the consortium holds the contracts there may be less need for separate data submission, but it will be all too easy for personal vendettas, misunderstandings or incompetent appraisals to cause victimisation.

In any case, how does one judge one's fellow professionals? Even if assessments are performed by GPs, what is to stop them from doing it in the blunderbuss manner of NHS Bedfordshire, surcharging practices that don't conform to simplistic prescribing targets, ignoring individual GPs' professional opinions, and without exception reporting? Practice appraisals in the brave new world of the White Paper will have to be vastly more sensitive than this.

Consortia will neither be able to keep control of their budgets, nor make commissioning work properly without legally based, ethical and robust mechanisms for assessing, confronting and, if necessary, punishing poor performance.

So politicians beware: unless you give consortia real teeth, and practices real protection, your proposals will fail dismally.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Just published

Hospital entrance

NHS England issues warning over norovirus and rising winter pressures

Almost three times as many people were in hospital with norovirus last week compared...

BMA Northern Ireland GP committee chair Dr Alan Stout

Northern Ireland GPs face deepest-ever crisis as practices hand back contracts

Northern Ireland's GP leader has warned that general practice in the region is facing...

GP consulting room

GP appointments hit record high of over 34m in October

GP practices delivered a record 34.3m appointments in October this year excluding...

GP consultation

New contract that enforces continuity would make GPs and patients safer, says watchdog

A new GP contract that makes continuity of care an 'essential requirement' for practices...

GP receptionist on the phone

Some practices to receive funding to upgrade digital phone systems

GP practices whose digital phone systems do not meet new NHS England standards will...

Woman using mobile phone

Safety issues with remote GP consultations 'extremely rare', study shows

Safety incidents are 'extremely rare' in remote GP consultations but risk is higher...