GP consortia face overhaul after NHS Future Forum report

Freedoms for GP consortia look set to be radically diluted after the independent NHS reform review panel called for a series of additional duties and safeguards to be put in place.

The NHS Future Forum report, submitted to the government on Monday, backed substantial changes to the Health Bill. The wide-ranging report called for a requirement for consortia to consult other health professionals during commissioning.

It also said plans to increase competition in the NHS must be scaled back.

The government must also take ‘sufficient time’ to ensure changes to education and training are handled correctly, the report warned.

The NHS Future Forum report said there should be ‘strengthened duties’ on consortia to secure multi-professional input into the commissioning process.

It said there should be a ‘strong role’ for clinical and professional networks, with multi-speciality ‘clinical senates’ providing advice to consortia.

Where consortia cannot demonstrate readiness to take on their new responsibilities they should not be allowed to do so, the report said.

In these cases, the NHS Commissioning Board should take on the commissioning role until consortia are ready.

The NHS Commissioning Board should be established as soon as possible to provide ‘focused leadership’ during the transition, the report said.

Some GP consortia may have to rethink their geographical boundaries, after the report said consortia should not cross local authority borders.

It said any departure from this must be ‘clearly justified’ and the boundaries of consortia and local authorities should support integration, not hinder or complicate it.  

The report said consortia should not be given total freedom to determine their own governance arrangements.

It said at a minimum, consortia should have a governing body, with independent membership, which holds meetings in public and consults publicly on commissioning plans.

It said: ‘These safeguards will help secure the best outcomes for communities and help guard against any conflicts of interest.’

But it said consortia should be required to include ‘independent representation’ on their governing bodies with specific responsibility for ensuring that their ‘duty to involve’ patients and the public is fulfilled.

Health and wellbeing
The report also called for the role of health and wellbeing boards to be strengthened, with responsibility to agree consortia commissioning plans.

These boards should also be able to refer concerns about commissioning consortia’s commissioning plans to the NHS Commissioning Board and contribute to their annual assessment, the report said.

The call is in direct opposition to calls made by the House of Commons health select committee for health and wellbeing boards to be scrapped.

Meanwhile, the report said competition has a place in enabling choice and improving quality in the NHS. But it said the message that it will not be appropriate everywhere has not been made clear enough.

The Future Forum recommended that the Bill should be changed to be ‘very clear’ that economic regulator Monitor’s primary duty is to ensure the best care for patients, not to promote competition.

It said the institutional duty on Monitor to ‘promote’ competition should be replaced with a ‘new right for patients’ to challenge commissioners at a local level where they feel choice does not exist or where services are not good enough.

‘Further policy work is needed to ensure this right to challenge will lead to real change, driven by patients and citizens,’ it said.

The report has also called on the government to take ‘sufficient time’ to ensure an ‘orderly and safe transition’ to the new education and training arrangements.

Education and training
Where the plans for the new local education and training boards are not in place by the time the SHAs are abolished, the workforce functions related to educational commissioning and workforce planning and the post graduate medical deaneries should be transferred to a host organisation until the new organisation is functioning.

NHS Future Forum chairman Professor Steve Field, said: ‘It was right to pause and reflect. It has, however, been a destabilising period for the NHS and an unsettling time for staff and for patients. It is time for the pause to end.

'If the substantial changes we propose are accepted by government, then I believe that the resulting framework will place the NHS in a strong position to tackle the pressing challenges in the years ahead.’

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