What does being part of a consortium actually mean?

Consortia across the country are in very different stages in their evolution. Under the Department of Health’s (DoH) Pathfinder Programme, some GP practices have signed up to be consortia or be part of larger consortia comprising of two or more practices. While some are still in their embryonic stages others are fully formed and functioning bodies. Until Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) are formally disbanded[*], consortia are effectively “shadowing” these former bodies. Commissioning healthcare, is perhaps the most widely publicised role of the consortia that will be devolved from PCTs, but they will also inherit several other statutory duties previously fulfilled by the PCTs and SHAs e.g. adhering to anti-discrimination law, following EU procurement law and cooperating with local authorities to improve the well-being of children.[i]

From one perspective “all GPs are involved in commissioning. Every time a GP sees a patient, they decide whether to prescribe medication, refer them to another part of the NHS or admit them to hospital. These decisions are based on the GP’s training, experience and knowledge of hospitals, services and secondary care clinicians, and all of these elements are considered in consultation with the patient.”[ii]

On the other hand only a handful of GPs from each locality will represent their colleagues on consortia boards and committees and be actively involved in thrashing out the details of commissioning contracts[iii].

Depending on how local services are being restructured as a result of a consortium’s actions, local GPs not directly involved in commissioning committees may have noticed either significant or very little change.

How do the salaried GPs feel about it?

Salaried and sessional GPs make up a significant proportion of the GP population. In certain urban settings they may even form the majority. Consortia are being encouraged to reflect this in the composition of their boards. Individual practices should involve sessional GPs in the decision making processes.[iv]

It is difficult to determine an overall sessional GP perspective on commissioning as each consortium appears to have a unique means of recruiting GPs to their boards with some actively involving salaried GPs and partners whereas others have exclusively involved partners.

It must be borne in mind that some salaried GPs have opted for a salaried position in order to be excused from the managerial/administrative burden that comes with partnership.

How do the GP Partners feel about it?

For a variety of reasons the bulk of involvement in and leadership of consortia currently appears to be from GP Partners. This may reflect recruitment strategies of consortia, actual and perceived seniority, being placed at more direct financial risk and greater general experience and specific experience of previous NHS restructuring programmes.

How do GPs in general feel about it?

While greater involvement of GPs in commissioning is broadly regarded as a welcome and positive step, some clinicians appear to be totally in favour of the proposed reforms in their totality i.e. including the abolition of PCTs[v]. The remainder is either undecided or deeply sceptical.

Table 1. A summary of potential benefits and drawbacks of commissioning proposals

How does it affect jobbing GPs?

Again, the extent to which jobbing GPs will be affected will be determined by a) whether they are directly involved in the commissioning process and b) local service redesign as a result of their workplaces being involved in commissioning.

Will I be able to refer patients where I / they want?

One of the key benefits cited of the proposed reforms is to offer patients even greater choice. Patients can currently choose which hospital they wish to have elective surgery performed at. The proposed NHS reforms wish to extend patient choice with suggestions such as scrapping practice boundaries so patients can register with any GP they wish to, whether they are local or not.

The potential sequelae of just this proposal itself highlight some of the key concerns regarding the restructuring programme. If consortia are entrusted to commission healthcare locally and institute local service redesign as part of this process, it’s difficult to envisage GPs referring patients outside of these new pathways thereby in effect limiting patient choice. Consequently clinician referrals may be more directed and directive too.

The provision of home visits and out of hours care for patients who may not live locally would also need to be addressed. It is unlikely you would receive a home visit from your preferred GP if their practice was a 2½ hour drive away.