GPs remain in the dark over whether they can form consortia from non-neighbouring practices.
UPDATED 26 April
It has emerged that at least one primary care trust, Barnsley, has told two groups of practices they cannot be awarded pathfinder status because their members are not all neighbouring.
PCT board papers say this is a problem because of “implications for commissioning of emergency services and services to non-registered patients within a defined geographical area”.
It would be unclear who would be responsible for accident and emergency services or patients who were not registered with either group, according to the document.
However, there are already some pathfinder consortia elsewhere in the country formed from non-neighbouring practices. A senior commissioning source familiar with the Barnsley case said it was unclear whether it was in line with DH policy.
Meanwhile, The Practice, a GP led company with around 50 practices across England, said it was “currently unclear” whether it would be allowed to form a single consortium. The company is believed to be seriously considering the option, although a spokeswoman said it had not yet decided.
Some GP commissioners have argued that allowing like-minded practices or those with similar populations to group could make them better commissioners.
Allowing non-geographical consortia could also be the basis for more competition between commissioning groups covering wide and overlapping areas.
However, non-geographical consortia pose several potential problems in addition to those set out by NHS Barnsley. The Liberal Democrats are concerned that joint working with local authorities would be hampered, and others worry that better performing practices could group together, potentially exacerbating health in-equalities.
An NHS Barnsley spokesman said in a statement: “NHS Barnsley has not told local GPs that they cannot become pathfinders.
Pathfinder applications were submitted to Yorkshire and the Humber who are the authorising body for the pathfinder process. The SHA deferred approval of the applications as they had concerns regarding the overall scope of the applications; one of those concerns related to the non geographical alignment of practices within proposed consortia.
NHS Barnsley continues to work with local GP groups to develop an approach for consortia that will meet not only Pathfinder requirements but will be sustainable into the future.”
The Department of Health said all consortia would have to be responsible for a defined geographic area for certain purposes, including commissioning A&E services and for the unregistered, but they could also have member practices from outside this area.
A spokesman said: “One of the key benefits of GP-led consortia is that they vary in shape and size, because they respond to the needs of different local areas.
“Although each consortium will be responsible for certain specified services, such as A&E services, in a defined geographic area, this does not mean that every GP practice in a consortium necessarily has to be located in this same area. That said, we have been clear that it wouldn’t be very effective if the practices were not broadly from the same geographic area.”