Consortia management allowance will be in operating framework, says Nicholson

Speaking at the National Association of Primary Care annual conference in Birmingham yesterday, Sir David also hinted that the value of the allowance would be higher than the most negative projections.

Previous estimates by health think tanks and commentators have put the figure as low as £8 per patient or as high as £12 per patient.

Sir David said the Department of Health was working on setting the allowance, which he described as “the magic number”, as a priority.

He said: “There are some very important national things we need to do. We need naturally, very quickly to get a position around the management allowance for consortia. I know many people are very anxious about all of that.

“The likelihood is that we will be able to publish in the operating framework at the beginning of December what the number magic is. And it is in all of our interests for that magic number to be as big as it possibly can be,” he told delegates.

He also told delegates the Department of Health’s response to the white paper consultation would be published in December, saying he would be “surprised” if there were many changes, especially around GP commissioning.

However, Sir David called for consortia to be built slowly, so they were built from the bottom up, and that it was “not a race”. He noted that some pathfinder consortia that had formed already were “remarkably co terminus” with PCTs.

He said: “We need to go slow in relation to the building of consortia. We need to work with the practices and build on the basis of the same understanding, knowledge and commitment, and not start from the top and try and work it down.

“You won’t get the change if you try and be the first to do everything. It’s always important to have people at the leading edge but we need a focus on building support from within the consortia, because it will enable you to go much faster afterwards if you make that an absolute reality.”

Despite his words of caution over the pace of consortia creation, Sir David warned that speed was needed to secure NHS talent.

He said: “There are some fantastic people working in our systems – in our PCTs and SHAs – who have made a fantastic contribution to improving services for patients across the NHS. We need to as quickly as we can identify those people and get them into the new system to take it forward.

“We’re in grave danger of losing some of our best people if we don’t do that. I want you [GPs] to think very carefully about how we make that a reality.”

Sir David was noticeably more upbeat about the reforms than when he addressed the NHS Confederation annual conference just after the white paper’s publication.

He said: “Don’t underestimate the commitment that people have got at the top of the system to make this happen. This would be a scandalous waste of human resources, effort, time, organisational memory if we just end up with a rebadged set of organisations.”

He said he had come to the conclusion the reforms were necessary if the quality of services was to be significantly improved.

He said: “Would it really have made a difference to outcomes for patients, if we just had one last heave around practice based commissioning or one last heave around world class commissioning. If we’d done that for another two years, would we really have had a step change. The answer is no, we wouldn’t.”

Sir David finished by setting out six challenges he thought faced the NHS as a whole in making the reforms a success:

1. Making a reality of giving patients more empowerment, as this would be a “key point” on which the public would judge success;
2. Avoiding reinventing the old system “like the plague”;
3. Making tough decisions, for example of how much support to buy externally and how much to take from PCTs;
4. Avoiding commissioning consortia “essentially turning into a GP’s club” by building in the rest of primary care and secondary care;
5. Delivering a step change in the quality of primary care;
6. How are we going to build the capability of you all.