A quarter of primary care trusts are racing ahead to hand over commissioning budgets while a third have no clear plans to “let go”.

An HSJ analysis based on information from 114 PCTs reveals 30 have already delegated significant commissioning budgets to emerging shadow consortia, or are ready to do so from next month. The total funds to be delegated are at least £7.6bn.

A further 48 PCTs said they were developing plans to delegate budgets but were unlikely to do so by next month.

But the remaining 36 - including some areas where there are “pathfinder” commissioning consortia - said they had no clear plans to delegate.

The most comprehensive analysis so far of GP practice membership of emerging consortia across England, also published by HSJ this week, shows that around 260 practices, with a 1.4 million registered population, are not yet in a consortium. For another 4.5 million people the situation is unclear.

The NHS operating framework for 2011-12 says PCTs should be confirming the “delegated responsibilities of pathfinder consortia” between January and March. It says one of the measures of PCT performance will be the proportion of commissioning budget delegated.


the average consortium population

Commissioning leaders have told HSJ that in many areas emerging consortia, including pathfinders, are not ready for delegation. In some cases this is because too few practices are engaged in the policy, or because consortium leadership is not in place.

Some have not yet decided which consortium to join or are choosing to remain independent for the time being.

NHS Alliance chair Michael Dixon said: “I would be slightly concerned if much more than a quarter were thinking about budgets. In some cases the consortia are not in a great state and the leadership has a one man and his dog feel about it.

“There is extraordinary variation and it calls for a gentle take-off of the policy.”

He said in undeveloped areas GPs should be building relationships with each other and other clinicians, managers and organisations, not taking on budgets.

However, some of those involved in the reforms are concerned PCTs are refusing to “let go” of control, and being guided by regional and national NHS management to prioritise efficiency savings and other performance over delegation.

Others warn the process of clustering PCTs is also distracting from consortium development in some areas.

North East Essex GP commissioning group chief executive Shane Gordon said it was important to delegate early so consortia are ready by April 2013, when they are expected to fully take over from PCTs.

He said: “In the operating framework and the transition letters from [NHS chief executive] Sir David Nicholson the primary concern is financial control.

“That is understandable but to me the difficulty is there are only two years to practise this. The operating framework language is focused on QIPP [the quality, innovation, productivity and prevention programme], whereas GP commissioning is about PCTs letting go.”

Charles Waddicor, NHS Berkshire West chief executive and NHS South Central commissioning development director, said that delegation was an important part of development.

The strategic health authority has told all PCTs to delegate at least 25 per cent of their budgets from April.

He said the DH and SHAs were clear about the importance of consortia development.

He said: “We have forced PCTs’ hands in a way and made it mandatory [to delegate]. Some have done much more than that [25 per cent].

“The message is you have to both get a grip on the money and you have to develop consortia because they are going to be taking things forward. If people are only hearing one of those they are not going to get it right.”

PCT Network director David Stout said: “The key question is whether consortia are ready to take on responsibilities, as much as PCTs being risk averse and unwilling to let go.”