GPs are forming commissioning groups that do not cover a defined geographic area, sometimes excluding lower performing practices.

The move appears to run contrary to instructions and guidance issued by the Department of Health.


PCTs with some non geographically defined consortia

Three Birmingham PCTs and Sandwell

There are a large number of emerging consortia, many of whose practices are mixed geographically, including across PCT boundaries.

Several sources in Birmingham said discussions were taking place between GPs and consortia about how to co-operate across the city and the Black Country to enable the mixed, some quite small groups to continue.

Emerging consortia identified include:


Black Country GP Consortium


Sandwell Health Alliance

United Birmingham Consortium


Pioneers 4 Health



Integrated Care Commissioning

Birmingham Inner City Consortium

Birmingham Independent Commissioners


Forward Health

Leeds PCT

There are three emerging consortia which are significantly mixed geographically. There are a relatively large number of so far independent practices, also scattered. They are understood to be considering joining existing consortia or forming a fourth.

They are: Calibre, H3plus, Leodis

A source in the area said they were planning a Leeds-wide collaboration which would help with commissioning for non-registered populations and accident & emergency services; but there were still questions around community services, for example.

Wigan PCT and Halton & St Helens PCT

There are several consortia across the two PCT areas one of which – United League Commissioning – straddles the PCTs boundary and is mixed among other consortia.

Wirral PCT

Three consortia - Wirral GPCC, Wirral HCC, and the much smaller Wirral NHS Alliance are mixed geographically.

James Kingsland, member of Wirral NHS Alliance and a DH adviser, highlighted the benefits to remaining independent and creating new structures with like minded practices.

South West Essex PCT

There are five emerging consortia at least who of which – Basildon Independent Care and South Essex Managed Care – are mixed geographically.

PCT GP commissioning project director Mandy Ansell said: “There are currently five GP formations in the south west Essex area; however it is expected that this number will decrease as GPs formalise their consortia arrangements. The white paper does not envisage individual practices forming their own consortia and it is likely that the NHS Commissioning Board will provide further local support to ensure all GPs are aligned to a consortium.”

Barking & Dagenham PCT

Two consortia are geographically mixed: Barking & Dagenham Quality Healthcare Commissioning Consortia and United Medical Consortium.

PCTs with some non geographically defined consortia, and where figures suggest one is former from better performing practices or those serving less deprived areas



Heart of Birmingham

In Heart of Birmingham, the Pioneers 4 Health consortium’s patients appear to cost slightly less to the NHS: £567,530 per 1,000 compared to the PCT average of £604,230, for a set of services included in the DH’s analysis of historic spending. The average index of multiple deprivation of its practices is 36.8 compared to PCT average 48.4. However, its practices’ average 2009-10 quality and outcomes achievement was less than their neighbours.

Wolverhampton City PCT

There are two geographically mixed consortia. Wolverhampton City Consortium, which has many more practices, scored 92.9% on the QOF and had a patient cost of £715,580 per 1,000. The smaller Wolverhampton Primary Care Consortium scores 94% and has lower patient costs, of £618,330 per 1,000. The smaller consortium’s patients are more deprived, though.

A spokesman said the small – apparently higher performing consortium – had formed from smaller practices which did not want to group with larger practices. He said their GPs were often more experienced and were known locally to make less referrals. He accepted this may cause them to be more efficient, making it easier to achieve financial balance. However he also said the group had less patients overall so would be more susceptible to the risk of one-off very expensive patients.

Barnsley PCT



Barnsley Commissioning Consortia and Barnsley People’s First consortia are geographically mixed. Barnsley Commissioning Consortia , which is smaller, scored 94.6% on QOF and has a deprivation of 25.6. Its patient cost is £854,220 per 1,000. Barnsley People’s First deprivation is 32.7, QOF score was 93% and cost per 1,000 is £906,730.

Mid Essex PCT



Essex GP Commissioning is a small seven-practice group with practices spread among a much larger Mid Essex Consortium, covering the rest of the PCT. Essex GPC has QOF achievement of 96%, cost of £544,180 per 1,000 and deprivation of 8.6. The larger group has QOF achievement of 94%, cost of £582,510 per 1,000, and 11.6 deprivation.

Essex GP Commissioning lead Les Brann defended the arrangement, saying it was good practices with similar populations and characteristics to come together.

Heywood, Middleton and Rochdale



GPCARE is one of three consortia in the PCT area, with Heywood and Middleton and Rochdale West. GPCARE has 93.5% QOF score compared to a 90% PCT average; £681,920 cost per patient compared with £738,680. Its deprivation is 36 compared to 38 PCT average.

The PCT said: “At this stage there are no plans to merge the three emerging consortia – they do however work closely together within a federated arrangement.”

Director of strategic commissioning Lesley Mort said: “Through our GP Commissioning Consortia transition programme, we are working with all three of our emerging consortia to prepare them for authorisation by 2013."

North of Tyne PCT

There are two geographically mixed consortia - CareFirst Community Interest Company and Engage Health. Engage Health has fewer practices, its patients cost £796,130 per 1,000 and deprivation is 20. The larger CareFirst has patient cost of £826,570 and deprivation of 26.3. The performance on QOF is similar: 95.6% for CareFirst and 95.5 for Engage Heath.

Milton Keynes PCT:

See main story.

City and Hackney PCT:

See main story.