Mills & Reeve explore how consortia in Cambridgeshire have involved GPs from the start to smooth the transition.

This article was part of the Commissioning Legal Adviser channel, in association with Mills & Reeve. The channel is no longer being updated.

NHS Cambridgeshire started working towards the creation of GP commissioning consortia in 2009. The aim was to improve efficiency and reduce spending – in particular, to stem a continuing growth in unscheduled admissions. Dialogue with local GPs was central to the proposals and the project was well developed and nearing launch by the time the White Paper was published. Few changes were required to adapt to the Government’s direction of travel. NHS Cambridgeshire’s vision was essentially mirrored in the Paper.

GP clusters in Cambridgeshire have established as non profit making companies. By setting themselves up as separate legal entities, this has provided flexibility and greater autonomy. The consortia companies are able to enter formal contracts with the PCT and others, distinct and separate from the GP practices represented. As part of their new structures, the consortia have needed to develop a robust governance and accountability framework to work within. This work will prove invaluable in developing appropriate governance arrangements for the new statutory commissioning consortia, with the huge advantage of having put the framework into practice first. 

The arrangements between the consortia and the PCT are contractual. The contracts are drafted flexibly to allow the list of care pathways for which the consortia commission services to be increased gradually over time. Support from the PCT in terms both of commissioning expertise and back office functions is an integral part of success and early on the PCT developed an HR framework outlining the different ways in which consortia could access support. 

In Cambridgeshire, four consortia companies have been formally launched and the PCT is also working closely with a former well established PBC group. 

The PCT, as the statutory body responsible for providing services, still retains responsibility for ensuring care needs are met. However, NHS Cambridgeshire hopes that, by involving GPs at an earlier stage, a smooth transfer of statutory responsibility can be achieved in 2013, when the PCT is set to be abolished. By this date, the consortia will already have a firm understanding, based on practical experience, as to what is involved in commissioning on this scale.