The BMA GP Committee has published guidance for GPs on forming commissioning consortia.

It includes the suggestion that the minimum sensible population size for a commissioning organisation is 500,000 – suggesting a maximum of 100 across England.

The guidance said consortia smaller than this should form risk-sharing confederations. It said: “They could then appoint a lead consortium or use a shared-service agency, employing management staff, to work on behalf of all members of the federation.

“The BMA believes that consortia or federations with populations of less than 500,000 will struggle to manage financial risk.”

If the guidance were followed there would be fewer commissioning consortia or federations than there are primary care trusts.

GPC deputy chair Richard Vautrey said in a statement, “any arrangements… should be flexible enough to deal with changes and nothing should be set in stone at this early stage”.

However, the guidance suggests:

  • Practices could elect a ‘board of appointment’ to recruit and appoint the key executive positions. The BMA believes consortia leaders should have a mandate from all practices within their consortium and it would be inappropriate for early adopters to assume leadership, or for PCTs to select a leadership team.
  • Consortia whose natural health populations mean they are at the lower end of the recommended 100,000–750,000 population range should consider joining together as a federation with other consortia.
  • In order to avoid conflicts of interest consortia could split the commissioning of specialist services into two separate strands. The designing of the care pathway, which would be clinician-led, and the procurement of the service, which would be carried out by appropriately skilled managers.
  • Consortia may want to co-opt secondary care clinicians onto specific subgroups to aid collaboration in service redesign.
  • Commissioning meetings could be open to members of the public so they can observe the work of the consortium and submit their own views.

Separately, GPC chair Laurence Buckman has opposed a significant element of the government’s commissioning proposals. In an interview with Pulse magazine he suggested there should not be financial incentives for good financial performance or reducing demand on acute services.

He said: “If there is a suggestion if I under refer, under investigate and under prescribe, somehow I will benefit from that financially, that’s a very dangerous path. I’m happy to be paid to do it, but I don’t want a direct link between what I save and what I receive as payment.”