NHS Reform: Who’s Gonna Count the Beans?

Here’s a simple question about the NHS reforms – who’s going to count the beans? Bean counting gets a bad press, but as soon as someone fails to count the public sector beans – for which read “the taxpayers money” – properly all hell breaks loose.

So imagine how surprised I was to hear a Tory MP say that the GP Consortia (GPCs) were already set up in his Constituency and raring to go – they wanted to take over today! Really? If they do it shows just how unfit for the job they are.

There are indeed lots of GP Consortia – my GP has been part of one for ages. But as far as I know none of them has direct control over the commissioning finances yet and, rather more to the point, none of them has a financial system capable of doing the job either. at the moment all finances are still channelled through PCTs systems.

If GPs do take over £80bn, as is constantly cited, and there are 1,000 GP consortia (it’ll probably be less) then each of them will have to have a financial system capable of handling £80 million a year. At the money, this money flows through PCT’s financial systems. Presumably every GP Consortia will have to have its own financial system and in the spirit of these “letting a thousand flowers bloom” reforms I also assume they can choose systems and suppliers for themselves?

The only alternatives – with Strategic Health Authorities and PCTs gone – would be either to have a centrally imposed, one-size fits all, system or for the DoH to manage all the finances centrally, with Consortia just making the decisions about where the money goes. That would seem unlikely.

So how and when will these new GPC financial systems get into place? They cannot even be specified until (a) the legislation is passed; (b) it is turned into detailed guidance about how GPC’s have to manage the money (there will be rules); (c) the GPC’s are established and decide what they want. Only then can they even start the process of commissioning a bean counting system. No wonder there is talk of “delay” and “natural breaks” – regardless of the politics, the shear practicalities of changes on this scale means it is highly unlikely to be done successfully on the current timescales.

Of course, I may be wrong. It wouldn’t be the first time. So if anyone knows that there is a plan out there that will allow all these GPCs to handle the £80bn please do tell.

Oh, and one last thought – who is going to audit them?

4 thoughts on “NHS Reform: Who’s Gonna Count the Beans?

  1. Colin
    A good observation and Ive just been reading in Public Finance that Grant Shapps is offering to eat his hat if the abolition of the Audit Commission doesnt save £50m by 2015(but he wouldnt expand on where his evidence came from when questioned by Clive Betts) ……and David Walker’s very sensible query about who will audit local authorities if NAO doesnt want to take the role over, or in an absence of a body similar to Audit Commission. Seems to me that the idea for GP Consortia for Commissioning in health and the plans to abolish AC (based on very spurious evidence of potential savings) are part of rather hastily thought out policy ‘on the hoof’. As you quite rightly say say ‘who is going to audit them?’

  2. Hmmm £80 million turnover isn’t that big. The income will come from one source – no customers to chase up – and the expenditure will mostly be in large chunks to health providers for commissioned blocks of services rather than in small spot payments. Nothing an off-the-shelf finance database and a small team of experienced finance admin couldn’t easily handle.

    Chances are lots of the new GP consortia will make a pig’s breakfast of it but on the face of it this shouldn’t be any great problem, unless I’m missing something.

  3. “inks” (I do wish would use there names, BTW)

    Whilst you are mainly correct about the income side, the spending side will be much more complex. The aim of the policy is that there should be many, not few, “bulk” contracts with a wide variety of providers. Also, as happened in the early 1990s, there will have to be a system for one-off extra contractual referrals for specialist needs not covered by normal contracts. So the spending side could, in fact should according to the policy, become very complex. And finally, GP consortia are themselves meant to be diverse and will probably therefore need tailored financial systems.

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