GP-led health service - New NHS year, new challenges

Dr Michael Dixon urges shadow consortia to be ready to dictate their terms for a creating a better NHS.

Dr Dixon: involving patients will be crucial for effective commissioning (Photograph: M Alsford)
Dr Dixon: involving patients will be crucial for effective commissioning (Photograph: M Alsford)

GP commissioners must use the next few months to create demonstratively fit-for-purpose organisations able to take on a shadow commissioning role and drive NHS reform.

Regardless of whether commissioning groups are subcommittees of PCTs (or local PCT clusters), limited companies or social enterprises, they will need to fulfil certain tasks. The first priority will be to define boundaries, choose which practices to include and ensure all GPs and practices have proper, mutual ownership of their consortium.

Consortia will need to put up inspirational and effective leaders, create inspired and enthusiastic followers and develop a strong clinical and management infrastructure.

All manner of outside agencies will be offering help, some championed by the local PCT or SHA.

GP commissioners will need the wisdom of Solomon to decide whose advice can be trusted, who should be directly involved and how they will procure the necessary interim support.

Meanwhile, each commissioning group will need to forge a strong relationship with its local population - possibly through practice patient participation groups which can collectively create patient ownership of the consortium.

Bringing in patients early will be crucial for effective, engaged commissioning and necessary to create a local political consensus that can act as ballast against unwanted external interference. Consortia will also want to engage with all primary care professionals and specialists so they feel involved in making coherent, cohesive and informed plans.

While moulding an organisational form, consortia will need to show they are up to the tasks ahead. The first step may be to draw up a list of local priorities for change and agree them with clinicians and local people.

Redesigned services
From this list they then need to develop a clear picture of how local services and health can be improved in a way that makes the value of GP consortia self-evident. Each consortium also needs to look at the 'low hanging fruit' in terms of redesigned services and demand management that can quickly have a major impact on reducing costs.

Clever use of communication and media to develop your consortium's 'story' will be every bit as important as working out details of how plans will be delivered.

As if all this were not enough, consortia will need to keep an eye on the national picture to ensure their priorities remain those of local people and clinicians. Some have said there is a danger that market ideology may trump the views of local clinicians and the needs of patients. More specifically, there are fears that the NHS Commissioning Board and regulator Monitor might seek to put their priorities first.

Collectively consortia have enormous national bargaining power and they will need to make sure this does not happen. The NHS Alliance will be there all the way with local GP commissioners to ensure that roadblocks do not halt them.

There are many who say GP commissioners will not deliver. We must prove our worth and be prepared to dictate our terms for a creating better NHS.

  • Dr Dixon is chairman of the NHS Alliance.

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