Just before last Christmas on the day that the government published its response to the NHS White Paper consultation, it also published the NHS Operating Framework for 2011/12.
Those GPs who are starting to play a fuller role in NHS commissioning will have recognised the potential impact of this document on their work over the next year.
On 31 January, an even more significant guidance note was published, outlining how PCTs will be clustered together for their final two years of life. The covering letter to this guidance explained that the purpose of clustering and other DoH activities is to develop a more powerful grip on performance and finance in the two years before the demise of the old order.
Gripped by management
'Grip' is a powerful image and a long-term theme of NHS management. While up until now most GPs think they have a lot of experience of NHS management, I suggest that few of them have been fully 'gripped' by it.
This will change: the government has become as interested in the way in which the NHS works during the transition to 2013 as it is in the post-2013 reforms. It has recognised that, with the loss of many PCT staff and the abolition of SHAs in April 2012, there may be a loss of control over resources.
The government's answer is to cluster PCTs on larger sites leaving about 50 rather than the 150 or so that have existed until now. The DoH thinks that having a smaller number of PCTs will make it easier to control them controlling the money.
This will cause problems for the developing GP commissioning consortia. Those consortia that want to take over the reins in the next two years will only be able to do so within the existing law. That law is clear: until PCTs' abolition GP consortia will work as sub-committees of PCTs. Those with good relationships with their PCT have been making detailed plans for how to carry this out.
But then, shazam!
Suddenly the managers of the PCTs you have been working are being booted upstairs to a super-PCT some distance away. Over the next few weeks, these new organisations will be formed, covering a number of different consortia. Lead GPs will need to forge new relationships, and the PCT clusters will be told to get a tighter grip on performance and finance.
It does not take much imagination to see whom they will be getting a grip on. If GP commissioning consortia want to create their own future, they are going to have to fight for the flexibility to do that.
- Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at www.pauldcorrigan.com