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Commissioning: Viewpoint - Dilemmas for GP commissioners

Consortia must seize the initiative despite contradictory pressures on them.

Dr Gordon: pitfalls and booby-traps
Dr Gordon: pitfalls and booby-traps

GPs can be forgiven for not knowing whether their time has finally come or not.

The NHS Alliance and the National Association of Primary Care (NAPC) are urging GP consortia to take the initiative to gain 'flying hours' in managing the NHS before the 2013 hand-over. Meanwhile, GPC chairman Dr Laurence Buckman counsels caution.

But what sets the White Paper's policy change apart from previous restructurings is the speed with which PCT staff appear to have accepted its main implications.

This brings both opportunity and threat. GPs have a chance to work closely with NHS managers in ways unthinkable during the practice-based commissioning (PBC) era.

But there is also a real risk that many talented PCT managers will flee to the relative security of the private sector or acute trusts.

Quick action to demonstrate what a future with GP consortia might look like is the only way to stem this haemorrhage of talent.

Many PBC consortia have formed organisations with legal status to further their efforts. Certainly this has been a key factor in my own consortium's success.

Ominous proposal
However, the ominous White Paper proposal that GP consortia will become statutory bodies makes forming robust organisations seem less attractive if they might be replaced in two years.

Another potential pitfall is the likely application of the Transfer of Undertakings (Protection of Employment) Regulations (TUPE) to posts in GP consortia. Careful footwork will be required to avoid triggering these legal landmines.

A season of union challenges may also ensue following Unison's threat of legal challenge to the NHS over the rapid pace of change.

Community nursing is high on the list of priorities for many potential GP commissioners and addressing the long-term conditions and urgent care agendas is crucial. Yet the current rush to hand these services to acute trusts will make service redesign trickier and remove a key carrot for GP engagement.

For quality improvement plans and management resources, £20 billion of productivity still needs to be found ?in the next three years. GPs must quickly take hold of this challenge and demonstrate their value in ensuring NHS stability.

Management support for GP commissioning is likely to be eye-wateringly low at a predicted £9 to £10 per patient. Consortia management allowances will be about a third of current PCT spend.

There must be increased reliance on technology and automated processes to live within these modest means and still deliver all that is required.

The path to a once-in-a-lifetime opportunity to secure the NHS's future is strewn with pitfalls, booby-traps and self-interest groups. GPs will have to be cunning and fleet of foot to achieve this, but they might just surprise the nay-sayers.

  • Dr Gordon is co-lead of the NHS Alliance's GP Commissioning Federation and a GP in Essex

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