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A bit more serious than an egg and spoon race


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Saturday, 28 August 2010

A bit more serious than an egg and spoon race

Some parts of the popular press are giving the impression that things are moving faster than they really are in the post white paper world of GP commissioning.

To judge from the trade papers, GPs are already racing headlong into "real" commissioning while indulgent PCTs stand on the sidelines cheering them on like fond parents at their child's first sports day.

The unexciting truth is that bar a couple of more radical experiments on the margins most of this "new" activity was already happening under practice-based commissioning.

There is nothing wrong with a bit of good old fashioned hyperbole and exaggeration, but let's not confuse the old with the new. GP consortia are not simply re-sprayed PBC groups. The moves from indicative to real budgets and from power-sharing arrangements with PCTs to the assumption of statutory powers are not just the logical next step, but a huge leap into the unknown for many GPs. The change from a voluntary to a compulsory GP commissioning regime is as radical as the difference between playing soldiers and joining the army.

GPs have been asking to have the shackles of bureaucracy removed, to be free to be clinical leaders, to make decisions in the best interests of their patients. The wish has been granted and now the full implications of liberation are becoming clear.

What is the right size for a consortium? How will risk by managed? What will be the financial impact on practices? What will it mean to fail? Who will commission services consortia are unwilling or unable to commission? How will joint commissioning work? Will consortia inherit PCT debt?

Nobody has the answer to these questions. Some of them will become clear in the autumn after the end of the consultation on the white paper. Other questions will take longer to answer and in many cases the answers will need to be found by GPs themselves.

With all this uncertainty, it is not surprising that fledgling commissioning groups are looking to the more mature PBC groups for a lead. These organisations have some experience of the sorts of issues likely to be faced by the new commissioning consortia, but they don't have all the answers either. For some, the advent of the new world will have a destabilising effect as their practices reconsider their options and neighbouring GP groups jockey for position. The mature PBC groups also face difficult questions of transformation into new-look consortia. They face the same uncertainties as fledgling consortia, compounded by the problem that bigger vessels take longer to turn.

It is difficult to find anyone who thinks GP commissioning is a bad idea. It is impossible to find anyone who thinks it will be easy.