Editorial: Don't let PCTs undermine GP commissioning

In all but a few shining pockets of the NHS, GPs' relationship with primary care organisations has never been plain sailing.

In England, PCTs have entered what looks like the final stages of their existence with clear instructions that GPs, via emerging consortia, should at last be involved in any decisions they take. Despite predictable reluctance from some managers to embrace GPs after spending years in an often adversarial relationship, many PCTs have finally brought out the peace pipe.

GP reveals this week that some GP consortia have been handed control of huge proportions of PCT budgets, a step that shows real confidence on managers' part in their ability to commission effectively.

But as ever with change in the NHS, progress is not straightforward.

LMCs have warned in recent weeks that GP consortia must beware of exposing themselves to legal liability for commissioning decisions. As statutory bodies, PCTs enjoy protection that consortia may not have unless they obtain written agreements establishing themselves effectively as subcommittees of the PCT.

But, on the other hand, getting too close to PCTs may carry a long-term danger.

Legal experts point out in this week's issue that PCTs may have an ulterior motive for getting close to consortia.

GP has reported that many PCTs are offering support from their staff for consortia.

But lawyers say this practice, along with subcommittee status, could mean consortia become liable under employment law for the jobs of PCT staff when the organisations are abolished, and for huge redundancy payments if they are unable to offer these staff long-term posts.

This is yet another confounding factor for the many willing GPs who have embraced the commissioning role the government wants them to take on.

Unless ministers get the Health Bill back on track soon, and ministers act to maintain the momentum of consortia, many GPs may yet walk away.

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