Resourcing GPs to commission
At the last National Clinical Commissioning Network meeting I was going to ask Sir David Nicholson and Dame Barbara Hakin whether we would be getting some National Guidance about how we should pay the GP leaders that are coming together in Transitional Leadership groups and Shadow GP Commissioning Consortia. (GPCC). I did raise the item informally but failed to push the question. It seems likely that we are too polite to haggle in public so I have set out some principles to guide our local group as follows.
Since we are keeping patients central to all we do we must ensure access to GP appointments is maintained. The surgeries have to be covered and the visits and administration must be completed on time.
In order for our practices not to lose out we must be able to backfill adequately. Standards must be maintained and this will require high quality locums and some flexibility on the part of other partners.
The GP leaders also, should not lose out so we need to pay them on a scale more or less equal to the day job.
Remuneration should be the same whether the GP leads are partners or sessional doctors.
Our local group have all agreed that we should avoid being seen to profit from this arrangement and since none of us have seen each other accounts we negotiating what we think is an average hourly rate sufficient to compensate for the investment required to learn new skills, read the papers and attend out of area meetings.
Interestingly we received a Freedom of Information request this week asking what we were paying the docs so perhaps some National Yardstick will ensue.
Apart from a need to adequately remunerate GPs on the board, the changes to the NHS may well have financial implications for all GPs not just those who choose to be leaders. Good commissioning starts with good primary care provision and if primary care takes on more from secondary care, resources will need to follow. We have yet to learn how the co-operation and competition panel will ensure we deal appropriately with ensuing conflicts of interest.
We do know that the NHSCB will hold GPCCs to account but also that GPCCs will need to monitor the performance of constituent practices. After all, some of our practice income will be tied to our collective outcomes and use of resources through the Quality Premium. Where outcomes are below standard and where unwarranted variation is suspected we will want to know why this is so and will ask for improvements to be made. If poor outcomes are due to poor provision more investment may be required from the profit sharing partners.
I remain positive that practices working collaboratively, with a shared sense of purpose, should be able to support and learn from each other, raising standards and driving out inefficiencies. Working together in GPCCs is a great opportunity for the combined knowledge and experience of GPs and their teams to inform the commissioning and provision of health care at both the individual and population level.
GP and National Clinical Leader
