The British Medical Association has declared GP consortia must be “democratically accountable” to practices. And they “should act with integrity and leadership when considering the accountability of practices”.

HSJ’s analysis of the spending behaviour of practice based commissioning consortia suggests these two aspirations could create considerable tension.

The fact that individual practices would be liable to overspend was seen as an acceptable price for clinically led commissioning. The argument went that consortia would smooth out these overspends by working with spendthrift practices and finding efficiencies. HSJ’s analysis suggests that - without direct financial incentives - this does not happen.

One of the most important accountabilities for practices taking on commissioning responsibilities will be that they live within their means. But if a consortium’s leadership really is “democratically accountable” to individual practices, it may find itself constantly threatened when confronting the overspenders. Much easier to accept the overspend and blame the lack of resources. If that happens, the NHS will struggle to improve in the cost-constrained decade ahead.

The accountability of overspending GPs