Shadow GP commissioning consortia should begin to form in this financial year and start to take some responsibilities from primary care trusts.
The Department of Health has published its plans for commissioning in a consultation document, Commissioning for Patients, following the launch last week of the white paper ‘Liberating the NHS’.
This set out plans for a massive reorganisation of the health service, including the abolition of strategic health authorities and primary care trusts, the creation of an NHS Commissioning Board and the transfer of many commissioning responsibilities to GP commissioning consortia.
In the latest document, the DH outlines plans to link GP practice pay to consortia performance, to rewrite the Quality and Outcomes Framework, and to give GPs a contractual responsibility to ensure efficient and effective use of NHS resources.
It acknowledges that good data will be needed and says that the NHS Commissioning Board will have a role in setting standards for information and making sure that IT systems work with each other to deliver it.
Commissioning for Patients says that consortia will be responsible for the “great majority” of NHS funds and will be expected to coordinate most of the clinical aspects of commissioning themselves.
They will be able to buy in support from external organisations, including independent sector providers, for other aspects of commissioning, such as population needs analysis and contract monitoring.
The DH says it wants to capitalise on the “existing expertise and capability” of PCTs in commissioning in the transition period, although it adds that: “We envisage that over time a more competitive market will develop for supplying some of these services.”
The DH says that in this financial year shadow consortia should start to take increasing responsibility for making commissioning decisions on behalf of PCTs.
The document adds: “This will mean PCTs increasingly putting management resources at the disposal of shadow consortia and working with them during the transition to ensure that appropriate skills and knowledge are retained.”
The DH pledged to work with the profession and the wider NHS to identify how to support consortia “in the significant challenge of accessing accurate, real-time data that can be translated into information to support efficient and effective care along the patient pathway."
It says the NHS Commissioning Board will have a role in setting technical and data standards to ensure consistency in the information that commissioners and providers are using “and compatibility between information systems.”
The document says the NHS Commissioning Board will calculate practice-level budgets. These will be allocated to consortia and consortia will have a duty to make sure that expenditure does not exceed allocated resources.
Subject to discussion with the BMA and the profession, an unspecified proportion of GP practice income will be linked to the outcomes a consortium achieves.
This will be achieved through a ‘quality premium’, which will be paid to a consortium, which wil then be able to decide how to share it out among practices.
At the same time, the DH says the NHS Commissioning Board will be able to ask consortia to carry out some of the work of managing primary care contracts.
This will include instances “where there are concerns that an individual practice is causing ineffective or wasteful use of NHS resources.”
The DH says the Quality and Outcomes Framework will be reformed because “it is now failing to deliver any significant degree of continuous quality improvement for patients”.
The new QoF will focus more on outcomes as previously announced in the NHS Outcomes Framework consultation launched earlier this week.
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.
It will also be publishing its own proposals for how GP commissioning could be made to work.
He added: “This is a challenging agenda, but the BMA is committed to try to find workable solutions that will fully engage both primary and secondary care doctors and the public so that by working in partnership they can achieve the best outcomes for patients.”
The document is out for consultation until 11 October.