The coalition government's aspiration that GP contracts should instead be held by the NHS Commissioning Board was one of the things about the White Paper that initially caused much head scratching here at GP.
Why should GPs be responsible for commissioning everything but primary care, which they know most about? The argument was, of course, that the original White Paper proposal avoided any conflict of interest.
The White Paper says that there should be a comprehensive system of GP consortia in place in shadow form during 2011/12. GP consortia will be established in 2012 and will hold contracts with providers in April 2013.
Health secretary Andrew Lansley has been criticised for the pace of change and, on the ground, practices are beginning to consider with whom they should join forces.
This week's GP newspaper reveals that LMC leaders are warning that it is unacceptable for consortia to develop entry requirements to stop poor practices joining.
Such behaviour is an understandable response to the skeleton detail set out in the proposals. After all, the White Paper makes it clear that consortium performance will be incentivised. Why should practice-based commissioning clusters take on struggling colleagues?
Perhaps key is that consortia will hold constituent practices to account for stewardship of NHS resources and for outcomes. Wouldn't it be a better idea for consortia to lead by example and take on poor performers to enable improvement to benefit healthcare across an area?
After all, the NHS Commissioning Board is responsible for ensuring all practices are consortia members and will be able to allocate practices to consortia if it needs to.
The question of whether consortia should hold GP contracts is a difficult one for Mr Lansley. Should he bow to pressure or does that risk putting too much power into the hands of those who lead consortia?
