In an Update on Commissioning Activity the college also predicts that a number of 'large outsourcing companies' and groups of other providers will become dominant providers of services to GP consortia as the market consolidates over time.
The report warns that confusion over the statutory responsibilities of consortia could remain for some time, because 'it has been suggested that there will not be significant guidance emerging from the DoH'.
The RCGP report says GP consortia must be of a scale to justify appropriate infrastructure support and to access capital.
‘Experience from the past has illustrated that in order to pool risk and to create economies of scale as well as being able to communicate on an equal level with large trusts and external bodies, that consortia will need to be of sufficient size,’ the document says.
The RCGP said each consortium should cover a population of ‘at least 500,000’, five times larger than some estimates suggest.
But the RCGP also highlighted that the exact size of consortia should be determined by local need, including local geography and existing care pathways.
Meanwhile, the college said it was likely that at least four separate models of commissioning support will emerge.
The first would see PCTs re-form as service provider organisations for GPs, as well as reconstructing themselves to provide support to emerging GP consortia.
It also proposed that GP consortia employ selected ex-PCT commissioning staff directly, but it said that this would be ‘unlikely’ to achieve scale to attract talent or investment.
A third option the RCGP outlined is for ‘large out-sourcing companies’ to develop ‘one-stop shop’ solutions. A fourth option, it said, was for various organisations who have a track record of redelivering ‘best in class’ solutions to come together in a consortia.