Commissioning consortia – functions and structure
The coalition government’s health and social care bill will devolve responsibility for planning and “buying” health services to general practitioners, cutting primary care trusts and strategic health authorities out of the picture.
General practices are expected to band together into consortia, which will be responsible for commissioning healthcare services - such as elective hospital care, out of hours services, and community health services – to meet the needs of the patients registered at the general practices that make up the consortium, as well as those who live within the consortium’s defined geographic area but are not registered.
In practice this will mean consortia will need to assess the healthcare needs of their population and identify likely trends, then design and commission services accordingly.
Exactly what shape commissioning consortia will take has been pretty much left up to general practitioners to decide. The 200 odd trial pathfinder consortia in England range in size from three surgeries covering 18,900 people in Hertfordshire to a group of 83 practices covering 672,000 patients in Oxfordshire. The average pathfinder consortium is expected to comprise 35 practices and serve 239,000 people.
However, the size and shape of a consortium will be informed largely by the natural health community within an area, how the consortium will relate to its constituent practices, how the consortium will relate to external organisations, such acute trusts and local authorities, and how financial risk can be managed, says the BMA’s General Practitioners Committee. And although the health bill refers to a consortium's “area,” a practice is free to join any consortium, not necessarily one that is geographically near to it.
Consortia can choose to commission services from local NHS providers or contract another organisation, such as a private healthcare company or a voluntary body, to do the work. This is where the “any willing provider” concept comes in – consortia will need to adopt competitive tendering to enable patients to choose from any qualified provider that wishes to provide the service. To facilitate this they can determine the prices or payments for services, subject to tariffs that will be set by Monitor and the NHS Commissioning Board.
Each practice will nominate a clinician to represent it on the consortium, who will then being asked to be part of decisions such as where investment or disinvestment is needed. It’s unlikely that most GPs will have a hands on, executive role in consortia, with practices being allowed to decide among themselves the level of involvement required of individual GPs.
All consortia will be required to publish a constitution, as well as a commissioning plan to show how they intend to use their budget and how they intend to improve outcomes for patients. Consortia will also need to hold open annual general meetings and publish an annual report.
Consortia will be responsible for looking after their own commissioning budget, including planning as cost effectively as possible to make sure their books balance at the end of the year and making arrangements to manage financial risk and plan for capital investments.
Consortia will be overseen by an independent NHS Commissioning Board, which will have the power to intervene where there is evidence that consortia are failing or are likely to fail to fulfil their functions.
Every consortium will have an accountable officer, most likely a GP, who will be responsible to the NHS commissioning board for the quality of services the consortia commissions, and for making sure it complies with its financial duties and provides good value for money. Consortia will be in shadow form until the end of this year and will become fully functional from 2013.
Department of Health. The Functions of GP Commissioning Consortia: A Working Document. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_125006.pdf BMA
General Practice Committee. The form and structure of GP-led commissioning consortia.
Map and data of GP commissioning pathfinder consortia.