Details have been published of how primary care services will be commissioned under the reformed NHS system.

The NHS Commissioning Board published the “single operating model” for how it will directly contract GP practices, pharmacy and ophthalmology services from April next year. Currently they are contracted by primary care trusts, which carry out the function in different ways around England.

The document published today, Securing Excellence in Primary Care Commissioning (see attachment, right), says: “Having a consistent approach will also help us tackle unwarranted variation and take positive steps towards raising the overall standard of primary care provision to the level of the best.”

It says the board will take a “professional and proportionate approach” to the task. The board will have to work in partnership with clinical commissioning groups, which also have a duty to help improve primary care services.

The operating model document says: “CCGs will not be responsible for contract compliance and will be able to focus on local priorities and supporting continuous development.”

The board’s national director for commissioning development Dame Barbara Hakin told HSJ: “Some PCTs have commissioned primary care really well, managing to achieve significant quality improvements while having a very good relationship with practices.”

She said the board would commission in that way. She said: “Commissioning well doesn’t mean being blunt or hard edged, because you don’t get the best out of people that way.”

Dame Barbara said for a small number of practices which are not delivering as high quality care as required – and where primary care had not previously been a major focus – there may be “more dialogue with them than in the past”.

The document says: “The most significant task is to standardise the performance management frameworks and processes at practice, provider and individual levels

“This takes place at a time of major change for GPs as they move to a new regulatory framework, including GP practice registration with the Care Quality Commission, potential professional revalidation and greater transparency of clinical indicators.”

Other documents seen by HSJ about the board’s plans for primary care contract management indicate GP practices will be divided into three categories based onperformance. They say there will be a “a risk based approach that describes the NHSCB relationship with practices”, and that practices will be split into three classes - “assurance based”, “room for improvement” and “cause for concern”.

The contract management framework has not yet been confirmed or published.