White paper gives NHS board right to stipulate PBC membership

The stipulation comes after Treasury concerns about the build up of significant gross under- and overspending.

Today’s white paper does not offer much detail on how planned GP consortia will work on a day by day basis, saying the finer points will be set out “shortly” in a further document, with legislation scheduled for a bill in the autumn.

A health bill to be introduced into Parliament in the autumn will establish how the government plans to devolve NHS commissioning to GP practice-based commissioners.

But the white paper does set the timescale for the transfer of the vast bulk of NHS commissioning to consortia.

Giving the commissioning board the final say over the membership and size of GP consortia could allow it to corral consortia to avoid significant under- and overspending, although health secretary Andrew Lansley denied he would dictate the size and geographies of GP consortia.

The white paper states that all GP practices will be members of a consortium “as a corollary of holding a registered list of patients”.

In autumn 2012 consortia will receive allocations “direct” for the financial year 2013-14 and from April 2013 – the date PCTs are “abolished” – it is consortia that will hold the contracts with providers.

Each consortium will have an accountable officer with the NHS commissioning board responsible for holding the consortia to account for financial control.

Although practices will have “flexibility” to shape consortia according to their own views on the best outcomes for patients, the white paper says the independent NHS commissioning board would likely reserve the right “to be able to assign practices to consortia if necessary”.

The paper also stipulates consortia should have “sufficient geographic focus” to be able to commission locality-based services such as urgent care, to take responsibility for patients not registered with a practice, and to work with local authorities in designing public health services.

The white paper further stipulates consortia will “need to be of sufficient size to manage financial risk and allow for accurate allocations”.

Academics have argued that would require consortia to cover population sizes around 100,000 population – which would mean there would be around 500 to 600 consortia nationally.

Allowing the commissioning board to dictate which practices form consortia will also mean it can minimise the risk of surplus-generating practices shunning over-spending practices.

Earlier this month HSJ reported gross under and overspending by practices could run to a minimum of £1.2bn a year (news, page 5, 1 July). That could create a problem for the Treasury if underspending practices were able to keep their surpluses, preventing them from being used to offset overspenders elsewhere.

Allowing the board to assign practices to consortia to could help ensure under- and over spenders balance each other out within consortia.

However, despite the references to geographies and size in the white paper, Mr Lansley denied his envisaged system involved any “top down” stipulation about the shape and size of consortia.

He said: “I’m not going to dictate. I’m not going to tell them what is the geography and size.”

The white paper also states patients will also be able to choose their GP, regardless of where they live, although that commitment includes the caveat that applies only to practices “with an open list”.

GP commissioners will have statutory duties and powers – established through primary and secondary legislation.

It says they will be responsible for “the great majority” of NHS services for their patients, although individual practices will not be able to commission themselves directly.

Budgets will be calculated on a practice-level but allocated directly to the consortia. Mr Lansley told HSJ those budgets would be allocated on the basis of equivalent access for equivalent need. Pressed on the precise proportion of the £100bn NHS budget practices would receive, Mr Lansley said reports it could be around 80 to 90 per cent were in the right “order” although some of that would include specialist commissioning which would be undertaken by the independent board.