Tim Riley on GP attitudes to commissioning consortia

Indeed, and possibly because of this mixed picture,  the GPs’ committee of the British Medical Association has been giving out some very balanced guidance on what these consortia are likely to look like. What’s more, there is even guidance that rather sensibly says how you might go about setting one up.

As a primary care trust chief executive, I cannot understand why committee chair Laurence Buckman and colleagues have not been providing this sort of quality objective guidance more actively in the past. In fact, I understand from chums in Richmond House that the next instalment is awaited to help inform how the implementation and practical detail should look, as we move toward Pathfinders and shadow consortia.

What is becoming more obvious from a local perspective is that the Liberating the NHS white paper and the proposal for consortia have got primary care (note “primary care” not just GPs) talking in a way I have not seen since primary care group days.

Yes, there are those who say this isn’t for them, but there is also a growing number who have worked out that doing the “steering” doesn’t mean they need to do all the rowing.

In some of our meetings we have had GPs who have quite seriously advocated new democratic means for people to run their health services and to take responsibility for their own health. At this rate, public health as a standalone profession is at risk of becoming redundant.

There are also those who are vehemently against all the white paper stands for. They believe the local pastoral nature of being a good GP will be lost to corporate business and mindless efficiencies that will only beget more bureaucracy.

These claims should not be dismissed as “off message” because the real trick to implementing health secretary Andrew’s Lansley’s vision is not to lose “localness” and the sort of care that is bespoke to family health needs. That sort of care is not just clinical; it is about how all the other aspects of care fit together so that the increasingly tax-burdened citizen keeps well, whoever is providing the care.

Let us not forget all the other primary care professions. One (among possibly many) lamentable fact of knowing that our PCT life is short is that there may be less opportunity to bring together commissioning for all primary care services alongside the provision of community services.

The NHS Commissioning Board is going to have to work hard if it is to join up primary care with community services. Again, this is not just about GPs but also our dentists, pharmacists and opticians. Their local representation does not quite have the national impact that local medical committees have through Dr Buckman and the GPs’ committee.

This is where PCTs can make a real impact on aligning the new agenda with the spectrum of primary care professionals. Engage all the local representation committees and help them navigate through the possibilities for how linkage between GP practices, pharmacy, dentistry and optometry can deliver better integration of provision and better commissioning of other care.

Don’t forget that commissioning is about designing relationships and that you need to have an intimate understanding of provision to do this right. Give consortia the resources to help them fly. After all, with Laurence Buckman’s guides, energised and idealist GPs and a real commitment from PCTs to let consortia succeed, this all just might work out.