Presentation on theme: "GP CONSORTIA Golden Opportunity or Poisoned Chalice?"— Presentation transcript:
GP CONSORTIA Golden Opportunity or Poisoned Chalice?
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?
The History of Change 1948 NHS Conceived 1974 Grey Book 1993 Fund holding FHSA HA merge 1983 Griffiths 1989 Internal Market 1982 Patients First PCGsPCTs 2010 GP Consortia TCS NHS Plan Royal Commission
Key Pledges First patients will be at the heart of everything we do 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. 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.
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
Scores poorly on responsiveness to the patients it serves Lacks a genuinely patient centred approach in which services are designed around individual needs
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
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
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
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
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 13 th July 2010
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
Timescales 2010/ / /13 April 2013 GP consortia begin to come together in shadow form Shadow consortia in place Establishment of consortia with indicative allocations. Preparation of commissioning plans Fully operational with real budgets
Large Option Population about 500,000 Approx 250 GPs Budget about £500m Management allowance approx £5m Support staff around 100
Small Option 4 localities of around 120,000 Around 60 GPs Budget approx £125m Management allowance around £1.2m Staffing support of about 20
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)
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
But will the GPs Buy into it? Ambivalence Poisoned Chalice Golden Opportunity Conflict - Individual / Collective New accountabilities Worries about privatisation Time to do it
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
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
Getting Themselves Organised SStakeholder Groups EExecutive Groups – by election CConsider governance arrangements FFederated Working LLinks with Public Health, & Patients WWorking with Health & Wellbeing Board & Health Watch LLinks with Hospital Consultants SSeconded Staff and building the new team
PCT Consortium Delegation as PCT Sub Committee Hand Holding Letting Go
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