Patients and other health professionals are being excluded from the “closed shop” of GP commissioning consortium boards, an HSJ investigation has found.
Details were obtained of the board arrangements for 51 of the 335 emerging consortia across England.
GPs and practice managers dominated the boards analysed by HSJ, none of which included a single clinician from the acute sector in a decision making role.
The figures reveal more than four out of five leadership roles are taken by those from the primary care sector. Two thirds of the consortia have at least one practice manager on their boards, while less than half have other non-clinical managers, including co-opted primary care trust staff.
The involvement of other clinicians in commissioning was one of the five “non-negotiable” demands set out earlier this month by deputy prime minister Nick Clegg to secure Liberal Democrat support for the reforms.
David Cameron appeared to support the idea, saying the government’s NHS listening exercise was “about reassuring clinicians in hospitals that they will have a really big part in the future NHS. The worry is I think when they hear… ‘GP commissioning’ they think it is only GPs that are going to be involved… That’s not the case”.
Royal College of Physicians president Sir Richard Thompson said: “Secondary care clinicians should not just be involved in providing advice to commissioners but also sitting on boards.”
Hospital doctors were concerned that commissioning with only GP input would “tilt the budget” away from hospital care.
He said: “The danger is that the GPs won’t fully understand what is happening in their local hospital and will be hoping to cut off some fingers and legs from the hospital’s budget.”
Public health and social care were both represented on fewer than one in 10 boards. Only 12 per cent had a representative of the local council and less than a third had a patient representative on their board.
The number of acute clinicians represented on consortium boards*
Jeremy Taylor, chief executive of patient group National Voices, said: “It is what we had expected in the absence of a clear steer from the government [and] a clear model of what works.”
He said there was a risk those excluded from commissioning would feel they had been “bounced” into decisions.
He said: “GP commissioning, without adjustment, is likely to lead to a closed shop of GPs without reference to the wider community.”
National Association of Primary Care chair Charles Alessi said: “Everybody has a legitimate place in commissioning. That includes [other professionals such as] nurses but… if someone doesn’t accept a treatment has to be managed within the resources… we’re in trouble.”
But he said the skills to run a GP practice were “very different” from the “more substantial” task of commissioning.
He said many practice managers were talented but added: “Let’s not kid ourselves that they have the full totality of skills.”
Nene Commissioning Community Interest Company in Northamptonshire currently has only GPs and practice managers on its board.
Head of communications and organisation development Ian Keeber said the consortium was “keen to avoid the potentially empty gesture of having a token nurse or token allied health professional on the board”.
In Milton Keynes, Premier MK consortium’s decision making body is made up only of representatives from its 13 practices. NHS Milton Keynes associate director of GP consortium development Janet Corbett said the government’s “pause” in its healthcare reforms “may result in others, for example acute care, being required members but that isn’t the case at the moment”.
Patient involvement and public accountability and clinical advice and leadership are two of four central topics being debated by the NHS Future Forum.
Health committee chair Stephen Dorrell questioned whether it was “appropriate” for consortia to make decisions about public money without representation from other parts of the health service.
He said: “If we don’t do that we will be condemned to failure.”
Regarding the fact that only four consortium boards for which HSJ obtained information had a public health representative, Mr Dorrell said: “I don’t understand how you can do the job of commissioning for a population without having a public health input. It seems to me that that is fundamental to the task.”
*sample of 51