1. Liberating the NHS: GP Consortia
South West Forum conference
9/10 November 2010

2. The themes in the
White Paper
 Putting patients and the public first: ‘no
decision about me without me’
 Focusing on improvement in quality and
health care outcomes
 Shifting power and accountability closer to
patients, with greater democratic legitimacy
 Transparency of information and choice for
patients
 Empowering clinicians: liberating the NHS
 Cutting bureaucracy and increasing efficiency

3. Liberating the NHS:
Commissioning for
patients
Gateway reference: 14833

4.  Devolving power and responsibility for commissioning of most
health services to groups of GP practices will empower health
professionals as leaders of a more autonomous NHS
 Commissioning by GP consortia would bring decision-making
much closer to patients and local communities, and ensure that
redesign of patient pathways and local services is always
clinically led
 GP consortia will have a duty of patient and public involvement
and will be held to account for this by the NHS Commissioning
Board
 GPs will work in partnership with secondary care, other health
and care professionals and with community partners to decide
how to use NHS resources to get the best health care and
outcomes for patients, through well designed, joined-up services
that make sense to patients and the public
 The intention is to put GP Commissioning on a statutory basis,
with powers and responsibilities set out through primary and
secondary legislation
What does it propose?

5.  DH will work with the NHS and other health and care
professions to promote multi-professional involvement in
commissioning
 GPs will work with local authorities, who will have a lead
role in ensuring services across the NHS, social care and
public health are joined up and meet the needs of local
people
 All GP practices will be required to be part of a consortium,
and ensure provision of services that support high-quality
outcomes and efficient use of NHS resources
 Not all GPs, practice nurses and other practice staff will
have to be actively involved in every aspect of
commissioning. Their main focus will continue to be on
providing high-quality care to their patients. A smaller
group of primary care practitioners are likely to lead the
consortium.
What does it propose?

6.  Consortia will not have to do all the commissioning work on their
own. They will have freedom to decide the best resourcing
approach for them, (e.g. direct employment, collaboration
across consortia, or external, paid-for specialist support (local
authorities, private and voluntary bodies))
 Consortia will receive a maximum management allowance for
commissioning costs
 A quality premium (proportion of GP practice income) will be
linked to the outcomes practices achieve collaboratively through
their consortium and the effectiveness with which they manage
NHS resources
 Primary Care Trusts will cease to exist from April 2013 - it is
important to capitalise on progress made and to harness their
existing expertise and capability in the transition period
 Implementation will be bottom-up, with GP consortia taking on
new responsibilities as rapidly as possible, with consortia fully
operational from April 2013. Consortia may grow from existing
PBC groups
What does it propose?

7.  Sufficient geographic focus will be necessary to
commission for locality-based services, unregistered
patients and to fulfil duties such as safeguarding of children
 GP consortia will commission most NHS services including
elective hospital and rehabilitative care, urgent and
emergency care (including out-of-hours), most community
health services, and mental health and learning disability
services
 To support GPs in their commissioning role, an
independent NHS Commissioning Board - duties will
include leading on quality improvement, promoting patient
choice and patient involvement, and allocating and
accounting for NHS resources.
What does it propose?

8.  The NHS Commissioning Board, supported by NICE, will
develop a commissioning outcomes framework
 The NHS Commissioning Board will be responsible for
commissioning primary medical services, family health
services (dentistry, community pharmacy, primary
ophthalmic services), national and regional specialised
services, maternity services and prison health services
 The NHS Commissioning Board will be accountable to the
Secretary of State for managing the overall commissioning
revenue limit and for delivering improvements against
health outcome measures. The Board will hold consortia to
account for their performance
What does it propose?

9. The proposed implementation timetable is:
 In 2010/11: GP consortia to begin to come together in
shadow form (building on Practice based Commissioning
consortia, where they wish)
 In 2011/12: a comprehensive system of shadow GP
consortia in place and the NHS Commissioning Board to
be established in shadow form
 In 2012/13: formal establishment of GP consortia, together
with indicative allocations and responsibility to prepare
commissioning plans, and the NHS Commissioning Board
to be established as an independent statutory body
 In 2013/14: GP consortia to be fully operational, with real
budgets and holding contracts with providers
When will this happen?

10. Establishing GP Consortia
 Development of a Commissioning Outcomes
Framework to focus priorities
 Approach to achieving change across the
system
 Variety of GP views about commissioning role
 Approach to formation of GP consortia
 Development of capability of GP consortia
 Transition for Primary Care Trust functions and
staff
 Approach to commissioning support

11. Process and progress in
the South West
 Early stages – GPs have met together twice to
think through their approach
 Levels of commissioning and options re
consortia size
 Getting authorised – what will it require?
 Commissioning competencies – how to get
them?
 Pathfinder process – encouraging applications
 Working with Primary Care Trusts and
supporting QIPP implementation – looking after
the inheritance!

12. Commissioning Process
Assessing Health Needs
Establish local priorities
against Outcomes
Framework
With patients and full range of health
and care professionals , decide what
services will best meet those needs.
Review service provision
Design services
Create clinical service specifications
Publish commissioning plan /
intentions
Establish contracts
Monitor and manage
performance
Review of
commissioned
services
Impact on Outcomes
(and reporting)
Patients
Public

13. Early implementation tasks?
 Forming Consortia
 Developing a Consortia health and healthcare
quality (and outcome) based strategy
 Demonstrating arrangements to commission at
all levels – for authorisation
 Demonstrating access to competencies:
clinically led / assured – for authorisation
 Identifying added value of GP Consortia (Do /
Assure)
 Getting started - sorting out all the practicalities

14. Commissioning provision –
early challenges?
 Need for strong fit-for-purpose delivery system in each
health community
 More choice for service users and provider income
dependant on those choices!
 Potential for increased use of third and independent
sector provider – Any Willing Provider model
 Transforming Community Services: take forward
opportunities for improving services as well as
organisational change
 Develop approach to support integration of care delivery
 Promote opportunities for development of strong social
enterprise sector
 Develop approach to financially challenged trusts and
recognise need for review of viability for certain
organisations

15. Conclusion
 Key tests for GP consortia to deliver as
part of the wider changes:
 Improved outcomes
 Improved productivity
 High standards of quality and safety