Dr Hamish Meldrum, BMA Council chairman, said the proposals contained both opportunities and threats but that the BMA would be actively involved in the consultation process.
The document is out for consultation until 11 October. GP consortia to start work this year Shadow GP commissioning consortia should begin to form in this financial year and start to take some responsibilities from primary care trusts.
The government apparently believes that for GP practices this will make for happier working relationships than many have experienced in trying to work with their PCTs to make practice-based commissioning succeed. Joining forces Currently, many GPs are thinking about which practices they would like to join forces with to commission healthcare and, no doubt, some will be thinking about a practice or two they would prefer to see joining someone else's consortium.
The White Paper states that 'practices will have flexibility within the new legislative framework to form consortia in ways they think will secure the best healthcare and health outcomes for their patients'. Achieving huge savings for the NHS while providing improving patient care mean that consortia will need to develop strong working relationships between their member practices. While their role and functions will be determined by legislation, how to do this needs careful consideration.
There are reports of early adopters courting top performing practices. This may leave the less attractive practices on the shelf - for example, those with high referral or prescribing rates or poor patient satisfaction levels.
Irrespective of this, all practices should plan ahead and start talking to each other about what future consortia and models of provision may look like locally. Stewardship of resources We are told that the NHS Commissioning Board will be responsible for holding consortia to account on 'stewardship of NHS resources' and outcomes for their population, and that sanctions on underperforming consortia will be financial.
In turn, it seems that consortia will be expected to hold their constituent practices to account. The consultation paper Liberating the NHS: Commissioning for patients states consortia may be required to undertake 'promoting quality improvement, reviewing and benchmarking practice performance and ensuring clinical governance requirements are met'.
Given this, each consortium will need to start preparing the ground rules on how they will interact with practices to ensure that:. Once member practices have signed up to these ground rules, the consortium will need to appoint the key individuals who will lead the transition to becoming operational and ensure they have the sufficient time and resources to perform this role appropriately.
Now I am sure most GPs are good and honest folk with only the best interests of their patients and the taxpayers at heart.
Especially as it could almost certainly be justified as providing better local care for patients. But I'm sure somewhere in this gargantuan bill, so big it can definitely be seen from space, there are a whole set of clauses and rules making sure that GPs themselves, personally, can't benefit from controlling all that NHS money, isn't there?
I'm just worrying needlessly, aren't I? Colin Talbot is professor of public policy and management at Manchester Business School. This article has been republished from his Whitehall Watch blog , which he writes in a personal capacity. This will mean more than just a token 'patient representative'. All constituent practices should have a democratic process through which patients help to identify the needs of the registered population and how best to meet those needs.
Reinforcing the multidisciplinary approach Of all patient contacts in the NHS, 80 per cent are within general practice and number some million consultations a year. Focusing the majority of clinicians' commissioning efforts on improving efficiency, demand management and health outcomes at that patient interface is appropriate. However, as with previous clinical commissioning development, consortia need to ensure an inclusive and multidisciplinary approach to patient needs assessment and care delivery by involving all healthcare professionals working in general practice and the community.
Working closely with local authorities There is a clear and urgent need to start dialogues, new relationships and integrated working with local authorities LAs , in particular with social services. Strategic planning at consortia level needs to be closely aligned with the public health agenda as this will be part of LAs' remit.
Current commissioning expertise at LAs needs to be aligned with GP consortia commissioning. Creating a seamless service An integrated approach to maximise quality and productivity has long been debated and desired. Consortia must facilitate dialogue between primary and secondary care clinicians about right care and best care pathways.
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