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.