The management of risk will be the main area of tension between fledging GP consortia and primary care trusts over the coming months, a report on the lessons learnt from practice based commissioning suggests.

The discussion paper – Putting GP led commissioning into practice – was compiled by the PCT Network based on interviews with PCT staff and GPs in areas where the last government’s policy of practice based commissioning was successful in redesigning services.

It says the two groups “appeared most polarised in their attitudes towards risk”. GPs felt PCTs were over bureaucratic and slow in approving innovative services, while PCTs said GPs failed to grasp the complexity of their statutory duty to ensure services did not fail.  

The paper says: “PCTs have sometimes been reluctant to move beyond well-established approaches because of an understandable desire to ensure systems do not fail. PCT managers feared GPs undervalued some processes around governance.”

It quoted a GP commissioning lead who said the PCT spent more time on risk management than on commissioning. He said: “We come up with an idea, it goes through our [consortium] board, gets approved and gets lost for months [at the PCT].”

However a PCT manager told the report authors GPs “underestimate the complexity and some of the processes around procurement and governance to make sure new systems are safe and effective”.

The report advises that in discussions with fledgling consortia, PCTs need to “be clear where responsibilities lie” until consortia are established on a statutory basis themselves.