The transition away from PCTs ahead of 2013 is already proving to be one of turmoil. NHS Cambridgeshire have elected a group of eight GPs to form a commissioning senate that will help smooth the way as consortia emerge.

One of the challenges that all primary care trusts face is providing coordinated and effective leadership during the transition process through to 2013.

NHS Cambridgeshire saw a need to put GPs at the heart of all commissioning decisions during this period and approached this challenge by setting up a GP commissioning senate in March this year.

Role of the GP senate

What is the role of the GP commissioning senate – why was it needed? The main focus of the senate will be to:

  • provide clinical leadership at the heart of NHS Cambridgeshire
  • achieve a smooth transition to GP Commissioning by beginning to build key elements of the new system well before 2013

The senate is a group of eight elected GPs who have been given the responsibility for ensuring that decisions made by NHS Cambridgeshire over the next two years are understood and owned by GP-led commissioners.

NHS Cambridgeshire director of strategy and delivery Andy Vowles explains: “We have worked closely with our board, local GP commissioning groups and the local medical committee to create the senate in a way which will provide coherent clinical leadership for the organisational and financial challenges we face.”

The senate will be in place until April 2013. It represents all Cambridgeshire GPs and will take a leadership role in managing the transition to GP led commissioning in Cambridgeshire.

Formally, it is a sub-committee of the board, with delegated authority for decision making on issues within its remit. 

“We believed that forming the senate could help the PCT focus on delivering important objectives in the run-up to 2013 and move away from less important projects,” says Guy Watkins, chief executive of the local medical committee in Cambridgeshire.  

“We were delighted to run the elections for seats on the senate to ensure it could demonstrate democratic credentials and to guarantee that all GPs on the local performers list were eligible to stand and vote regardless of their position within or without a practice,” says Dr Watkins.

Across the county

Cambridgeshire covers approximately 600,000 patients and has a number of well developed GP led commissioning groups providing local leadership.

The commissioning senate will be responsible for making decisions on issues which cannot be taken at a local level, such as countywide quality, improvement, productivity and prevention initiatives.

The senate will also ensure that local GP led commissioning groups are properly supported by NHS Cambridgeshire staff.

They will also ensure that processes required to configure and develop commissioning consortia are robust and will oversee the development of future commissioning support.

Each of the eight elected GP members has a defined constituency within Cambridgeshire, and all committee members will have dual accountability to NHS Cambridgeshire’s board and to GP practices across the area.

GP commissioning senate chair Simon Hambling says: “It makes perfect sense for GPs to take ownership of the decisions that will affect them in the future when they take on responsibility for commissioning decisions.

“It is early days for the senate, but we are working closely with our colleagues from NHS Cambridgeshire to draw up a list of priorities and to develop action plans for how these priorities will be delivered in the future.”

Dr Hambling adds: “The way the senate has been set up means that we are accountable not just to the public for the way that we will commission services in the future, but also to our GP colleagues.”

All GPs on NHS Cambridgeshire’s performers list were offered the opportunity to put themselves forward as candidates for the senate.

Aspiring senate members were required to meet a broad person specification, followed by a local election process, run by the local medical committee, to allow local GPs to vote for candidates.

To help with the election process, Cambridgeshire was divided into four constituencies and the membership structure of the senate was designed to ensure that each constituency was appropriately represented (see table).

Structure ensures each area is represented

AreaNumber of seatsPopulation
Borders, Fenland2111,000
Isle of Ely/East Cambridgeshire183,000
Greater Cambridge3271,000


In leading the transition the senate has clearly defined expected outcomes to help it continue the drive in quality and partnership working. It will ensure vital building blocks for the new system are in place for 2013.

What will the commissioning senate achieve?

Expected outcomes; September 2011

  • A clear consensus locally on the desired “end state” of commissioning consortia
  • An agreement on how risk sharing, if needed, could operate;
  • Significant progress should be made in developing internal governance within emerging end state consortia, building on the experience of working with the local medical committee to hold elections within existing GP led commissioning organisations;
  • Progress is expected in building patient and public involvement into emerging consortia;
  • All GP led commissioning organisations within NHS Cambridgeshire have change plans in place (a list of their early priorities). It is anticipated that this approach will be extended to any future arrangements for consortia;
  • GP commissioning senate and GP led commissioning organisation leads will be involved directly in the performance management process with the local strategic health authority/shadow NHS commissioning board;
  • The GP commissioning senate will lead on operational planning for the financial year 2012-13;
  • GP commissioners will lead on the 2012-13 commissioning contract negotiations, which will be overseen by the GP commissioning senate;
  • GP commissioners will take the lead from NHS Cambridgeshire in driving up quality in primary care, building on the work that has already been carried out by GP led commissioning organisations in Cambridgeshire;
  • All relevant staff at NHS Cambridgeshire will be directly allocated to GP led commissioning organisations or within a commissioning support function.

Expected outcomes, April 2012

By this time commissioning consortia and the senate should be taking the lead on almost all issues, with NHS Cambridgeshire offering support as required.

This would work as follows:

  • Well resourced and established local commissioning organisations making steady progress towards becoming successfully authorised as consortia and working to a clear and resourced development plan;
  • Emerging consortia with an agreed constitution will be able to cover all of the requirements included in the Health Bill, such as procedures for decision making and conflicts of interest. They would also have a shadow accountable officer in place;
  • All NHS Cambridgeshire staff “assigned and aligned” to GP led commissioners, local government or the NHS commissioning board;
  • Joint working arrangements to be set up between GP led commissioners and the shadow Health and Wellbeing Board agreed;
  • A clear scheme of delegation between the residual board of NHS Cambridgeshire and local GP led commissioners. This will include risk sharing and sharing resources and/or functions;
  • A clear plan will be put in place for accessing commissioning support after the PCTs are dissolved;
  • Clarity will be achieved around the new public health service and the agreed shadow health budget assigned to it.