Pardon my ignorance, but I have been trying – and I confess failing – to try and get my head around a simple question: who owns (or rather will own) GP consortia? The legal status of these bodies may seem a bit pedantic, but it could have a fundamental affect on the dynamics of the New Model NHS. And finding out, from the 367 pages or whatever it is of the Health and Social Care Bill is nigh on impossible.
Most people forget, if they ever knew, that GPs are not NHS employees but independent contractors. Although some work in NHS premises, many (most?) own their own buildings and single or group GP practices are small businesses. Many GPs have already done very nicely by using NHS funding – quite legally – to improve buildings and businesses that they own.
Primary Care Trusts (PCTs) are, on the other hand, publicly owned and controlled bodies. GP Consortia (let’s call them GPCs for short) seem to have a rather more ambiguous status. Are they public, or are they private, or some sort of hybrid?
The reason it matters of course is that if these GPCs are going to be managing 80% of the NHS budget, or £80bn in today’s budgets, what incentives will they have? If, for example, they are essentially private small businesses then the is every incentive for them to bias decisions in their favor. Because, when they are “commissioning” care they could, if the system allows this, commission themselves instead of NHS Trusts to provide services. This could be either as a GPC or, presumably, as GP practices? Either way, they could stand to make money, either directly or indirectly, from such decisions.
GPCs will also have, of course, a budget for running themselves. In some cases, they will presumably be collocated with GP practices. Again, how exactly will the private interests of the GPs who own these medical businesses be kept separate from the (presumably) public GPCs?
Now I am sure most GPs are good and honest folk with only the best interests of their patients and the taxpayers at heart. But some might not be, and the temptation could be very great indeed to cream off a little of that £80bn, could it not? Especially as it could almost certainly be justified as providing better local care for patients.
But I’m sure somewhere in this gargantuan Bill, so big it can definitely be seen from space, there are a whole set of clauses and rules making sure that GPs themselves, personally, can’t benefit from controlling all that NHS money, isn’t there? I’m just worrying needlessly, aren’t I?
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Colin,
Potentially the Bill does allow GPs themselves to make personal gain from the NHS funding stream.
Para 223L – Payments in respect of performance, s1 (page 41), states “the [NHS] Board may, after then end of a financial year, make a payment to a commissioning consortium if, in the light of an assessment carried out under…..it considers that the consortium has performed well during that year”.
This is further added to by 223L, s7 (page 42) which states – “A commissioning consortium may distribute any payments received by it among its members in such proportions as it considers appropriate”.
One might interpret this that a) bonuses will be paid, and b) they will go to supplement GP income. We await the DH translation of the Bill into (NHS) English so that we can determine the rules for preventing personal gain.
Don’t think it does, the money can be distributed to the practices themselves not the individuals running them.
I would recommend reading the transcript of David Nicholson + Una O’Brian at the Public Accounts Committee to look at their discussions of accountability in the new system. Also http://www.healthpolicyinsight.com/?q=node/934 has a good analysis of the statutory body concept for GP consortia.
The ownership question and controls are not academic. If lessons are to be taken from miner’s solicitors, financial institutions, and Network Rail it must surely be that absolute controls must be in place, with everything scrutinised independently, and nothing on this scale to be based on trust or expectations of professionalism.