Working with clinicians

The July 2010 White Paper 'Equity and excellence: liberating the NHS‘ introduced new arrangements to devolve budgets for local primary care commissioning to consortia of GPs. The new white paper is attempting to put power in the hands of patients and clinicians through GP consortia. It involves a framework where the redesign of patient pathways and local services is always clinically-led. It is also based on more effective dialogue and partnership with hospital specialists.

The new arrangements will bring together responsibility for clinical and financial decisions. They reinforce the important role of GPs in local service commissioning and enabling them to “strip out activities that do not have appreciable benefits for patients' health or healthcare”.

The Government, where possible, plans to build on existing arrangements with a number of GP consortia envisaged to emerge from existing practice-based commissioning. For example, although it is now proposed that PCTs will be discontinued from 2013, a number of PCTs have made important progress in developing commissioning experience. Over the next two years, they will be supporting practices to prepare for these new arrangements.

To support GP consortia in their commissioning decisions, the Government will create a statutory NHS Commissioning Board. This will be “a lean and expert organisation, free from day-to-day political interference, with a commissioning model that draws from best international practice”. The NHS Commissioning Board will provide leadership for quality improvement through commissioning guidelines, and standardising known good practice. The board will not manage providers or be the NHS headquarters.

Helping to provide evidence about local communities needs and aspirations, there will be a local HealthWatch, funded and based in local authorities and replacing local involvement networks (LINs). They will also have responsibility for complaints and advocacy. There will also be a national HealthWatch (based in the Care Quality Commission). This all helps reinforce the new role local authorities will play in joining up services and creating an accessable and supportive health service.

An overview from the white paper published in July 2010 'Equity and excellence: liberating the NHS'

The background information below from GP Commissioning to ‘An Autonomous Commissioning Board' to ‘Timetable for GP Consortia and the NHS Commissioning Board' is taken from the NHS White Paper: ‘Equity and excellence: liberating the NHS').

NHS White Paper: Equity and excellence: liberating the NHS - (PDF, 61 pages 339KB)

GP Commissioning

GP commissioning will be statutory, with powers and duties set out in primary and secondary legislation.

Consortia of GP practices, working with other health and care professionals, and in partnership with local communities and local authorities, will commission the great majority of NHS services for their patients. They will not be directly responsible for commissioning services that GPs themselves provide, but they will become increasingly influential in driving up the quality of general practice.

They will not commission the other family health services of dentistry, community pharmacy and primary ophthalmic services. These will be the responsibility of the NHS Commissioning Board, as will national and regional specialised services, although consortia will have influence and involvement.

The NHS Commissioning Board will calculate practice-level budgets and allocate these directly to consortia. The consortia will hold contracts with providers and may choose to adopt a lead commissioner model, for example in relation to large teaching hospitals.

GP consortia will include an accountable officer, and the NHS Commissioning Board will be responsible for holding consortia to account for stewardship of NHS resources and for the outcomes they achieve as commissioners. In turn, each consortium will hold its constituent practices to account against these objectives.

GP consortia will have the freedom to decide what commissioning activities they undertake for themselves and for what activities (such as demographic analysis, contract negotiation, performance monitoring and aspects of financial management) they may choose to buy in support from external organisations, including local authorities, private and voluntary sector bodies.

GP consortia will have a duty to promote equalities and to work in partnership with local authorities, for instance in relation to health and adult social care, early years services, public health, safeguarding, and the wellbeing of local populations.

GP Comissioning section (NHS White Paper Equity and Excellence)

An autonomous NHS Commissioning Board

NHS White Paper: Equity and excellence: liberating the NHS - (PDF, 61 pages 339KB)

The NHS Commissioning Board will promote patient and carer involvement and choice, championing the interests of the patient rather than the interests of particular providers. It will involve patients as a matter of course in its business, for example in developing commissioning guidelines.

To avoid double jeopardy and duplication, it will take over the current CQC responsibility of assessing NHS commissioners and will hold GP consortia to account for their performance and quality. It will manage some national and regional commissioning. It will allocate and account for NHS resources.

It will have a role in supporting the Secretary of State and the Public Health Service to ensure that the NHS in England is resilient and able to be mobilised during any emergency it faces, or as part of a national response to threats external to the NHS. It will promote involvement in research and the use of research evidence.

The NHS Commissioning Board will have five main functions:

1. Providing national leadership on commissioning for quality improvement:

2. Promoting and extending public and patient involvement and choice

3. Ensuring the development of GP commissioning consortia

4. Commissioning certain services that cannot solely be commissioned by
consortia, in accordance with Secretary of State designation

5. Allocating and accounting for NHS resources.

Timetable for GP Consortia and the NHS Commissioning Board

The below is taken from the NHS White Paper ‘Equity and excellence: liberating the NHS'

NHS White Paper: Equity and excellence: liberating the NHS - (PDF, 61 pages 339KB)

  • The board will be established in shadow form as a special health authority from April 2011
  • A comprehensive system of GP consortia in place in shadow form during 2011/12, taking on increased delegated responsibility from PCTs
  • Following passage of the Health Bill, consortia to take on responsibility for commissioning in 2012/13
  • In 2011/12 the board will develop its future business model, organisational structure and staffing
  • The board will be converted by the forthcoming Health Bill into a statutory body, with its own powers and duties, and will go live in April 2010
  • the NHS Commissioning Board to make allocations for 2013/14 directly to GP consortia in late 2012
  • GP consortia to take full financial responsibility from April 2013

Continue on to sister page: Our work so far and useful links

8 December 2010

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