Small consortia 'viable if risk shared'

'Best practice' council for GP consortia calls for learning networks.

Dr Amit Bhargava: consortia covering 40,000 patients are viable (NHS Alliance)

The size of GP consortia will not be important as long as risk is shared among neighbouring groups, a new commissioning council has concluded.

In its first meeting, the NHS Alliance's 'Commissioning Federation Council' discussed how to manage the move from PCTto GP-led commissioning.

The council is comprised of 24 GPs and clinicians, and includes both practice-based and PCT commissioners.

Its chairman, West Sussex GP Dr Amit Bhargava, said consortia covering as few as 40,000 patients could function if they shared financial risk with neighbouring groups, but a population of 100,000 was 'more manageable'.

About 500 consortia would be required across England if each covered 100,000 patients.

'There was a lot of talk about size,' Dr Bhargava said.

'Size is important but not as much as how you stratify risk. By collaborating, you can stratify risk so smaller consortia can function.'

Health secretary Andrew Lansley has refused to say what size consortia should be, but many experts say small consortia will be inherently unstable.

RCGP chairman Professor Steve Field said last month that just 'a few expensive patients' could cause a small consortium to overspend, and former DoH commissioning chief Mark Britnell has said they must be 'at least the size of PCTs'.

Dr Bhargava said the council felt consortia must be 'leaner (organisations) than we have ever seen before', if GP-led commissioning was to get off the ground and make efficiency savings.

'Learning networks' would be crucial to developing consortia, said Dr Bhargava. 'We need to avoid reinventing the wheel over and over again,' he said.

The federation's council will meet about four times a year and work with influential DoH figures such as England's national director for improvement and efficiency Jim Easton and NHS medical director Professor Sir Bruce Keogh.

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