Compulsory commissioning may be difficult, report warns

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.

It says allowing GPs to keep part of the savings would offer 'direct incentives' to practices, but admitted this might be hard at a time when public sector incomes are under scrutiny.

Another option is for GPs to be offered direct personal financial incentives in return for excellence in commissioning, under a new GMS contract.

'There is a need for sophisticated reward arrangements that would reflect different levels of achievement by groups in relation to health outcomes and financial control,' it said.

NAPC chief executive Mike Ramsden said: 'We will engage with the DoH to ensure there is both effective implementation of this major change and full and proper support for GPs to enable them to take on this new role.'

Commissioning Report
  • A 'one size fits all' solution will not work.
  • Determine how to set a fair budget and the services to include.
  • Work out how budgets are allocated and how performance will be managed.
  • Ensure the right mix of risks and incentives.
  • Work out if commissioning will be mandatory or voluntary.
  • Find ways to engage specialists in commissioning.
  • Ensure GP leadership is supported.

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