In its consultation on how GP commissioning will work, the DoH outlines that the exact proportion of practice income that will be linked will be ‘subject to discussions with the BMA and the profession’.
Liberating the NHS: commissioning for patients also said the NHS Commissioning Board, supported by NICE, will develop a commissioning outcomes framework by which consortia will be judged.
It said the framework will provide ‘clear, publicly available information on the quality of healthcare services commissioned by consortia, including patient-reported outcome measures and patient experience, and their management of NHS resources’.
The consultation added that the NHS Commissioning Board will have the ‘powers to intervene’ in the event that a consortium is unable to carry out commissioning effectively, or ‘where there is a significant risk of failure’.
‘We propose working with the NHS to develop criteria or triggers for intervention,’ it said.
GPC deputy chairman Dr Richard Vautrey said it was too early to rule out accepting DoH proposals that a proportion of GP income should be linked to commissioning outcomes.
‘This is not a discussion that’s started yet. As with all negotiations, we need to look at the whole package. These are details that will take a number of months to talk to NHS Employers and the government about. We will discuss anything the DoH brings to the table – whether we agree to it is a different matter.’
Meanwhile, the consultation document also outlined plans to allow consortia the freedom to allow some commissioning activities to be carried out at ‘sub-consortium’ or practice level, as revealed previously by GP newspaper (9 July 2010).
It also gave the green-light for consortia to buy in support from external agencies, including local authorities, private and voluntary sector bodies, to help with commissioning.
‘This could include, for instance, analytical activity to profile and stratify healthcare needs, procurement of services, and contract monitoring,’ the consultation document said.
The consultation document also said PCTs will have ‘an important task’ in the next two years in supporting practices to prepare for the new arrangements.
It said: ‘A number of PCTs have made important progress in developing commissioning experience. We will be looking to capitalise on that existing expertise and capability in the transitional period, where this is the wish of GP consortia.’
The commissioning consultation and the White Paper make clear that GP consortia will ‘not be responsible for commissioning primary medical services’.
But Dr Vautrey added that he believed commissioning consortia should have a clear role in developing services in primary care.
He said: ‘If enhanced services are part of developing the range of services on offer in an area, GP consortia would want to have a clear role in developing these services.’
He agreed that there would need to be a clear mechanism for consortia to influence the services that were developed, even if contracts with primary care providers were held directly with the NHS Commissioning Board, rather than consortia.
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