NHS White Paper - keep calm and carry on
The publication of the Government's White Paper entitled
Equality and Excellence: liberating the NHS on 12 July
has, inevitably, caused a huge amount of commentary. One of the
aspects on which there has been particular focus is the proposal
for putting local consortia of GP practices on the 'front line',
commissioning services for their local area and population.
Although the White Paper is bursting with ideas, it contains
relatively little detail and the Government has acknowledged that
it will need to carry out consultations in order to flesh out much
of that detail. One of those consultations, issued today (22 July)
is entitled 'Commissioning for Patients' and seeks views on the
intended arrangements for GP commissioning and the new NHS
Commissioning Board.
There is no doubt that if the changes proposed by the White
Paper are seen through to a conclusion it will mean huge changes
for GPs. Traditionally, GPs have worked in partnerships with only
very little formal dealings with other GP partnerships in their
area. The advent of practice-based commissioning groups and the
concept of Federations, promulgated by the Royal College of General
Practitioners in their paper in the summer of 2008, has led to some
associations between practices; some informal, some formal. However
the White Paper makes clear that GPs will be expected to join
consortia and in the event that they fail to do so voluntarily,
will be allocated a consortium by the NHS Commissioning Board.
This is a far cry from the way many GPs currently work and a
change of this nature is, inevitably, worrying.
However, Corporal Jones's old saying "Don’t panic, Mr
Mainwaring" is one worth bearing in mind. While GP consortia are a
new concept and there will be particular issues to deal with in
relation to commissioning and all of the other requirements that
are going to be imposed on GPs (as yet unknown), the notion of
organisations working together is not new.
It is very common, in the public sector, for groups of
organisations to get together, through contractual arrangements, to
deliver services. We already have some precedent through federated
structures already in use by some GPs. In the wider business world,
legal entities regularly form new organisations, either for a
specific project or for longer term purposes. There are various
tried and tested legal models and it is likely that elements of
them will inform the way forward structurally.
I entirely accept that there will be some very specific issues
to be addressed within GP consortia and, culturally, this type of
legal structure and arrangement will feel alien to many GPs.
However, today's consultation paper shows that the Government
anticipates that consortia will be statutory public bodies and that
their powers and responsibilities will be set out through
legislation. That suggests that there will be some basic structures
with which to work.
Legal advice inevitably involves a certain amount of lateral
thinking and drawing on other ideas and experiences, albeit from
different sectors. The White Paper states that the GP consortia are
to be in place, in shadow form, during 2011/2012. Whilst realising
that time can move extremely quickly, there is a strong argument
for keeping a watching brief on comments and guidance from the
Department of Health, responding to the consultations and reviewing
the outcomes of those consultations before any hasty action is
taken.
