Viewpoint - Keep consortia under GP control

Will consortia be interfering busybodies that know more about practices than PCTs?

Mr Cumberlege: flexibility lost
Mr Cumberlege: flexibility lost

What does the term 'consortium' signify to you when applied to practices grouped together to commission healthcare services?

GP commissioning consortia will be rather different to other types of consortia if membership is compulsory and they are not an umbrella body managing activity to achieve the aims all the members want.

Consortia can be enormously powerful as organisations with members bringing different skills and resources to achieve something that individually they could not. Within the NHS environment, many private finance initiative projects have been built and operated by consortia.

A GP consortium is an organisation whose members all provide largely the same service. This makes it rather different from, say, a consortium, of architectural firm, construction company, facilities management contractor and so on - each with specific skills which join forces to build and operate an NHS healthcare facility.

Commercial world
In the commercial world, it is quite common for competitors to create consortia. For example, pharmaceutical companies may join forces to carry out research, pool expertise and share costs and risks.

For GP practices, the big question is whether consortia will be of value to them. Or will they become controlling busybodies with more knowledge about you than PCTs?

In January, the Nuffield Trust published its report GP commissioning: insights from medical groups in the United States about practices in the US which are part of independent practitioner associations (IPAs).

This showed that the IPA consortia model assisted practices in achieving good and supportive management. Larger IPAs could spread financial and other risks wider, enabling them to provide more services and generate greater revenues.

However, the bigger and more complex the IPA, the higher the level of leadership required. Communication and management costs increase too.

These are issues many IPAs 'grew into', in some cases, over many years. Consortia will not have the luxury of time.

IPAs are voluntary. They not only choose their members but also the level of control and management.

In GP consortia, these aspects may be dictated by the DoH or be enshrined in statute law.

Also, in GP consortia, flexibility over how and when practices work together, and their relationships with each other will be largely lost if membership and constitution are imposed. The same applies to control over them. This could be a straightjacket in which practices' behaviour and processes are dictated, leading to resentment and disengagement.

The challenge is to prevent the legislation from burying the potential advantages of consortium membership: sharing and implementing fresh ideas and pooling resources for better outcomes for patients.

  • Justin Cumberlege is the partner leading the healthcare team at solicitors Carter Lemon Camerons LLP, www.cartercamerons.com

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