The Maynard Doctrine: Regulating GP commissioning consortia - who? And how?

Professor Alan Maynard considers the chaos, confusion and celerity surrounding the development and assurance of GP commissioning consortia.

As yet there is little enlightenment about how entry into GP consortia status will be achieved and what the powers will be given to the gatekeeper. This after one bland White Paper; a fistful of consultation documents; and much punditry from academe and think-tanks

The Care Quality Commission’s job is to license all providers, and this included PCTs when they ran community and other services. GP consortia are obviously providers of primary care, and CQC licenses GPs.

’Why have one regulatory licensing system for all, except GP consortia?’

So should CQC have the role of licensing GP consortia? It is strange that they do not have this role but that is the intention set out in the commissioning consultative paper.

But why have one regulatory licensing system for all, except GP consortia?

Quis custodiet?
If it is not the CQC, who will govern these bodies?  Local Health Watches and councils face major budget problems, and do not have the expertise to interrogate and hold to account wily GPs and their artful managers (if such people exist).

The NHS Commissioning Board risks turning into the second Department of Health by proxy. It is also clearly a female organisation - i.e. ambitious and multi-tasking!

What role will it have, in addition to such minor tasks such as managing the GP contract, ensuring financial balance, maintaining high-quality care and implementing NICE national performance standards?

Central planning office located
The commissioning consultative document plans to allocate the GP consortia regulator role to the NHS Commissioning Board, and to task it with setting entrance criteria and ensuring performance standards are met. Comrades! Does this sound like the new Central Planning Office of the NHS?!

How detailed or ‘lite’ will this regulatory framework be? With considerable rhetoric about “local” decision making and “autonomy”, one Government response may be in the Maoist tradition i.e. “let a thousand flowers bloom”. As Chinese communists discovered, this noble notion led to anarchy and regime change. This is an outcome that will not be relished by Tweedle Dee Dave and Tweedle Dumb Nick!

Clone Bill Moyes
So what to do? Perhaps the government either should recruit Bill Moyes or have him cloned! What is needed is a rigorous regulatory regime similar to that used by Monitor to judge hospitals for foundation trust status in the early years.

Only with clear entry criteria and performance plans will GP consortia drive efficiency without undermining the NHS.

Such processes would establish national standards for financial and quality control, with rolling three-year plans, adherence to which is monitored quarterly.

This would give Comrade Nicholson the assurance he desperately needs - i.e. ambitious and disruptive reform and static future funding can be managed to ensure some care for patients!

Incentives, GPs, QOF and income
Another related, quiet and evolving issue is the incentivisation of GP to ‘play’ the new Consortia game. Will the government be able to persuade GP leaders anxious for fame and ennoblement, to get the GP profession’s agreement to put part of their personal income at risk if Consortia under-perform?

An initial response would be that we are more likely to see pigs fly! But as Prime Minister Walpole reportedly noted two hundred years ago, every man  has his price. Perhaps GPs would accept some minor penalty for failure if, as part of the current bargaining, the income from the GP quality outcomes framework, was merged into basic pay?

Hopefully the government will not countenance such a ridiculous, expensive and inefficient notion - but you never know.

No doubt HM Treasury is watching how the Department of Health plans to deal with these issues. If the latter is tardy in setting out satisfactory plans, no doubt the Treasury will put the brakes on the NHS reforms.

At present, all eyes are on this issue - and the level of public enlightenment is noticeable by its absence!

’With NHS managers moving rapidly (and without legislative authority) to implement the reforms, slow articulation and implementation of the commissioning consortia management framework may be a recipe for considerable distress.’

Number 10 has already slowed the pace of reform by requiring legislation, but with NHS managers moving rapidly (and without legislative authority) to implement the reforms, slow articulation and implementation of the commissioning consortia management framework may be a recipe for considerable distress.

We know who is to set the standards for consortia - but the GP commissioners are evolving before the NHS Board exists even in shadow form, let alone begun setting entrance and performance criteria.

Reform currently consisting of backing blindly into unknown territory may lead to some rude shocks! That will be exciting “fun” for all concerned - except the patients, fearful of their fate in a frantically re-disorganising NHS.