Expert predicts GP consortia failure

Only one in 10 comparable bodies in the US - called independent physician associations - succeeded financially and in terms of improving patient care, Lawrence Casalino told the influential UK health think tank.

The professor of public health at Weill Cornell Medical College, New York, spent a month at the Nuffield Trust studying the proposed reforms to the NHS as part of the prestigious John Fry fellowship.

He concluded that without far greater emphasis on rigorous management than is currently planned, many GP consortia were doomed to failure.

Professor Casalino said: “Even with perfectly designed incentives in the commissioning system the risk of failure is high because of a number of factors.”

These included an inadequate supply of GP leaders; a likelihood of consortia under-investing in management; a lack of time to develop the right sort of “culture” and the possibility of a lack of cooperation from clinical consultants and hospitals. Professor Casalino said the best possible way of maximising the chance of consortia succeeding was not to cut management costs too harshly.

“It would be a huge mistake to cut management costs - it would be penny wise and pound foolish and lead to failure as we have seen in the US with independent physician associations,” he said.

Director of the Nuffield Trust Jennifer Dixon told HSJ “management was vital” and that investment in leadership was needed if widespread failure of consortia was not to follow.

At a separate event, Chaand Nagpaul of the British Medical Association’s general practice committee said it was going to be “extremely difficult” for consortia to take on many of the roles of primary care trusts with a projected 45 per cent cut in management budget.

Dr Nagpaul told the National Association of Primary Care conference in Birmingham the combination of the 45 per cent cut in management costs and £20bn productivity savings would make the transition “extremely difficult”.

• HSJ’s conference Information for GP-led Commissioning is in London on 1 December, see www.hsj-gpcommissioning.co.uk