Major questions remain over commissioning, say insiders

The government this week announced more than half the population was now covered by the early stage consortia, which it said was “evidence of widespread enthusiasm” for consortium commissioning.

A further two waves are expected to be announced in February and March. However, several senior NHS sources who are overseeing the process cast doubt over the degree to which pathfinder consortia were actually engaged.

One regional commissioning lead said it was “disingenuous” to claim the number of pathfinders was evidence GPs were enthusiastic because many member practices were not committed to the reforms.

A second senior source involved in the process in another region similarly stressed pathfinders were not yet taking on significant responsibilities.

The source said: “Having pathfinders means there is a sense of momentum growing, but they are generally not dealing with a large percentage of the budget.”

The source said, for example, very small pathfinders are likely to have to grow in order to manage financial risk. They said: “We still have to go through a process to see if these arrangements are sensible, and some [small consortia] will have to get a more [financially] stable footprint. There are still more questions than answers about the changes.”

The source said pathfinders would have to look at what it will take to get authorised for full responsibility “sooner rather than later”, and that has not yet been defined. When full responsibility becomes clear he suggested there may be more reluctance from GPs to take on commissioning responsibility.

There may also be dispute over whether the current pathfinder leaders have a mandate from their constituent practices, HSJ was told.

Richard Vautrey, deputy chair of the British Medical Association’s GPs committee, echoed the concerns. He said: “Many practices in pathfinders would say they are not truly engaged in the process.

“The current laissez faire attitude cannot go on indefinitely.”

However, NHS Alliance chair Michael Dixon said those involved in pathfinders were enthusiastic and the process would allow them to develop. But he said there was “a lot of ideological negotiation to be done” over requirements for becoming full consortia, for example how they would be governed.

The average population size in the second wave of pathfinders announced this week was 175,000, and the average for all pathfinders is 205,000. There are now 31 consortia with populations smaller than 100,000 and 18 with fewer than 10 practices. All regions now have pathfinders covering more than 29 per cent of their population.