GP Consortia

1. GP Consortia Golden Opportunity or Poisoned Chalice?

2. Questions We Would All Like Answering • Why GPs? • What are Consortia Expected to do? • What will Consortia look like? • What do GPs think of it? • What do others think of it? • How will GPs go about doing it? • What support will they need?

3. The History of Change 1974 Grey Book 1982 Patients First 1948 NHS Conceived Royal Commission 1983 Griffiths 1989 Internal Market 2010 GP Consortia NHS Plan 1993 Fund holding FHSA HA merge TCS PCTs PCGs

4. Key Pledges We will make the NHS more accountable to patients. We will free staff from excessive bureaucracy and top down control. We will increase in real terms spending on the health in every year of this Parliament. First patients will be at the heart of everything we do Second there will be a relentless focus on clinical outcomes Third we will empower health professionals. Doctors and nurses must be able to use their professional judgement about what is right for patients Health care will be run from the bottom up , with ownership and decision making in the hands of professionals and patients.

5. Why? • Compared to other countries the NHS has achieved relatively poor outcomes in some areas: • some respiratory disease • Some cancers • Stroke • Underlying risk factors need a focus from public health

6. Scores poorly on responsiveness to the patients it serves • Lacks a genuinely patient centred approach in which services are designed around individual needs

7. Why Professional Empowerment • The GP as Gatekeeper • Co-ordinator of care • Every GP decision results in expenditure • Nearest to patient – acts as patient advocate • History • GP Fundholding • Primary Care Groups • Practice Based Commissioning • GP Consortia

8. Why the GP? • Gatekeeper role • Ultimate initiator of health spend • Makes GPs responsible for expenditure • Contain ambitious consultant plans • Cheaper in Community • Better at achieving change • More acceptable to public – GPs are popular • Clinically Driven • GPs better at assessing Risk

9. Role of Commissioning Consortia • “The responsible commissioner” for any registered patients within constituent practices • Provision of comprehensive emergency services • Determining healthcare need • Determining what services are required • Managing contracts • Monitoring & improving quality • Oversight of providers training & education plans

10. GPCC Duties • Stay within budget • Equality & human rights • Data protection & FOI • Work in Partnership with LA • Inform, engage and involve the public • Develop its own arrangements to hold its constituent practices to account

11. Criteria for establishment of GPCCs “We do not propose to issue a Whitehall blueprint for the geography of consortia. We believe that GP practices should have the flexibility to form consortia in ways that they think will secure the best healthcare and health outcomes for their patients and locality.” Commissioning consultation document para 4.5 “It is the job of the centre to set clear expectations of GP Consortia and to ensure they have the capability to meet those expectations – but not to design or enforce their size, geographical coverage or precise management arrangements.” Letter from Sir David Nicholson to Chief Execs 13th July 2010

12. Fundamental Requirements • Universal Coverage – interlocking boundaries • Every GP needs to be a member of a consortium • Sufficient geographic focus to be able to agree and monitor contracts such as urgent care • Sufficient size to manage financial risk

13. Timescales 2010/11 GP consortia begin to come together in shadow form 2011/12 Shadow consortia in place 2012/13 Establishment of consortia with indicative allocations. Preparation of commissioning plans April 2013 Fully operational with real budgets

14. Large Option Population about 500,000 Approx 250 GPs Budget about £500m Management allowance approx £5m Support staff around 100

15. Small Option 4 localities of around 120,000 Around 60 GPs Budget approx £125m Management allowance around £1.2m Staffing support of about 20

16. Making it work Large consortium with sub localities • Devolved budgets • Management tiers • Locality committees • Can pay “big salaries” • Small consortia acting collectively • Lead commissioning / speciality leads • Collaborative commissioning • Single tier of management • Shared posts (eg finance)

17. What has the LMC Done? • Roadshows in each locality • Response to DOH consultation • Established GP Consortia Steering Group to oversee process of designating Consortia • Must be GP led • Must have democratic mandate • Needs to be inclusive of all GPs • Facilitating further debate / information with PCT support to enable informed choice by GPs

18. But will the GPs Buy into it? • Ambivalence • Poisoned Chalice • Golden Opportunity • Conflict - Individual / Collective • New accountabilities • Worries about privatisation • Time to do it

19. What Do Others Think? • PCT staff demoralised and leaving • Everyone is a GPs friend now • Existing GP leaders wanting to maintain power and influence • Ordinary GPs just wanting to do the day job • Consultants feeling marginalised • Nurses wondering where they fit • Unions opposed to change and sceptical • Third Sector worried

20. Pathfinder Consortia • Rolling Programme • 6 in North West in first wave • Within existing PBC rules • Must show GP engagement / support • LA involvement / support • Track record of success in handling devolved budgets and delivering QIPP • Not definitive for future • No extra funding

21. Getting Themselves Organised • Stakeholder Groups • Executive Groups – by election • Consider governance arrangements • Federated Working • Links with Public Health, & Patients • Working with Health & Wellbeing Board & Health Watch • Links with Hospital Consultants • Seconded Staff and building the new team

22. Delegation as PCT Sub Committee • Hand Holding • Letting Go Consortium PCT

23. Dangers • The Economy • Public hear the wrong message • Privatisation debate derails it • Too many hostile groups • Treasury caution • Professional cynicism • Lack of freedoms promised will lead to GPs becoming disillusioned • BMA