The Royal College of GPs has cast doubt on the ability of GPs to manage commissioning budgets, and predicted they will turn to a ‘consolidated’ market of support functions for assistance.

In a paper focusing on commissioning, the RCGP says it is “doubtful” that the GP consortia that will be set up as a result of the white paper, ‘Liberating the NHS’, will have the skills to negotiate with hospitals in the short term.

It says this poses the risk that consortia could fail to manage their budgets “almost from the outset."

The RCGP says consortia will require “high level general and specialist management support” and that most of this will be outsourced to the private sector.

Commissioning functions that could be outsourced include IT and analytics, data collection and analysis, transaction and contract management and performance management.

However, the RCGP predicts that the market for commissioning support will consolidate around ‘one stop shop’ solutions from large outsourcing companies and organisations with a track record of delivering ‘best in class’ solutions for the various aspects of commissioning.

A small number of external organisations could evolve to support large numbers of commissioning consortia if this happens; although the report suggests that consortia will need to cover populations of at least 500,000 to justify the costs involved.

The report also notes that the changes are liable to be controversial. It points out that some commentators fear that the reforms will lead to the privatisation of the health service and represent the denationalisation of the management functions in the NHS.

The RCGP has been actively engaged with commissioning through an alliance with Aetna and Price Waterhouse Coopers, which led to a successful tender under the Framework for Procuring External Support for Commissioners (FESC).

Its report says many commissioning support organisations are now “courting” the RCGP “as co-working with the College would provide clinical credibility and by implication substantial opportunities for income.”

The paper adds: “Our experience over the last 12 months with Aetna and PwC has given us considerable and valuable experience and our expertise and confidence has grown considerably. We are now in a better positionto understand how to use the private sector to best achieve our ends.”

The college has also published a White Paper Framework following a College Council meeting on the white paper. This outlines the views of members who have so far responded to the College’s consultation on the white paper.

The framework says GPs welcome the opportunity for greater GP leadership and influence in decision making, but are also concerned about the lack of time, skills and capacity for commissioning.

Professor Steve Field, RCGP chairman, said some members were unconvinced that the scale of the changes proposed in the white paper were justified in a climate of cost reduction.

He added: “Whatever the outcome of the white paper consultation the fundamental principles of the profession and of the NHS must be protected and above all the public must continue to receive high quality primary care.”