Why GP commissioning will be big business

It may not be universally popular, but it isn't going away. A survey released earlier this week suggests that only 23% of doctors think that the government's plans to transfer the commissioning of healthcare in England from primary care trusts (PCTs) to GP consortia will improve patient care ( article ). Health secretary Andrew Lansley said last week that he wants the reforms in place within two and a half years, and the first pathfinders will be chosen within weeks ( article ). He told the National Association of Primary Care (NAPC) conference in Birmingham, that the size and shape of the consortia will be chosen by GPs themselves. Dame Barbara Hakin, the NHS's managing director of commissioning development, supported Lansley in emphasising that there would be no more guidance on what consortia might look like. She told the audience that the government sees advantages in different sizes of consortia: smaller ones might be locally sensitive, while larger ones could be easier to deal with. Furthermore, she thinks it is likely that consortia will group together as federations to do some commissioning work. One of the few restrictions placed by Lansley on the pathfinder consortia is that they must have some kind of involvement with local authorities. This may make it more likely that some consortia will be bounded by a council area, but on the evidence of existing groups of practices, others are likely to involve GPs spread across many counties. The results could be seen as messy, or as offering patients more choice, something that would appeal to pro-competition Tories. GP business practices Comments from both Hakin and Lansley suggested there will be plenty of work available for organisations wishing to support the consortia. One GP from North Somerset already involved in practice based commissioning said this has meant spending evenings and holidays setting it up, and colleagues have resented it as a distraction from the day job. Hakin replied: "The answer to the question is mainly, you will have all the funding." In other words, consortia can buy support services as they see fit. This could well provide jobs for some PCT staff, which will be abolished by 2013 under Lansley's plans, and provide new work for existing NHS service bodies, such as regional informatics services. But it also means opportunities for commercial providers. The managing director of Capita's health division Beverley Bryant said the company plans to offer consortia a menu of services, including IT and informatics, estates and asset management, patient engagement, and communications and advice on governance and risk. Another exhibitor, United Health – known for providing GP services in a few areas – was talking about how it can provide services to GPs such as software tools, and has jointly published a guide to GP commissioning with the NAPC. The Practice, a company set up by doctors to provide healthcare services exclusively to the state sector, highlighted its operation of GP practices, walk-in centres, community hospitals, ophthalmology and sexual health services and prison healthcare across southern and middle England. Mark Britnell, UK head of healthcare at KPMG, announced that the professional services firm is setting up a commissioning academy with the NAPC next year. The conference also heard from a parliamentarian who has seen the English NHS change slowly but steadily over many years. Stephen Dorrell, who was health secretary between 1995-97, said: "Local management of providers is now accepted as a fact of life in the health service," well over a decade after he helped introduce it to the NHS. He conceded that GP commissioning, introduced by the Major government in its first form as GP fundholding, has not yet taken hold. "It's intensely frustrating," he said. "Tony Blair has said that he regards it as one of his biggest mistakes, to abolish fundholding. I agree." But Dorrell, who is now chair of the health select committee, said that while he supports "socialised healthcare" free at the point of delivery, he did not extend that support to central planning. "Free enterprise economies work better than planned economies," he said. There's little doubt that the current health secretary wants GP commissioning consortia to look more like the former than the latter – and that companies are likely to play a considerable role in making it happen.