What now for GP consortia?
pharmafile | July 13, 2011 | Feature | Sales and Marketing | GP consortia, NHS reforms
David Cameron unveiled major changes to the direction of the health reforms on 8 June – and in doing so, pulled the rug out from under the feet of GP consortia.
The first wave of GP consortia ‘pathfinders’ were only launched in September 2010, but had been encouraged by health secretary Andrew Lansley to take on as much responsibility possible, as soon as possible.
The revisions to the reforms mean that consortia will no longer be ‘GP consortia’ – they will instead be named Clinical Commissioning Groups and will include at least one hospital doctor, a nurse and two lay members.
Moreover, rather than power being transferred from PCTs to consortia in a ‘big bang’ moment on 1 April 2013, the transfer will be made only when local consortia are judged to be ready.
Even before the prime minister’s announcement, Dr Michael Dixon, head of the NHS Alliance, which represents primary care professionals, said pathfinder consortia felt ‘betrayed’ by the government’s U-turn.
Yet despite all the confusion surrounding the future of consortia, the new groups are here to stay. Led by some of the most ambitious GPs and managers, many will still be relied on to be the engine room for improving services.
And in many cases this will be with immediate effect, regardless of the 2013 deadline or any later ones.
GP consortia look to take on local budgets
GP consortia pathfinders have been encouraged to take on responsibility for budgets but have come up against major obstacles.
Yet consortia are not statutory bodies, which means they are not allowed to formally control the budget. To get around this, some areas have tried to give them a legal footing by giving them sub-committee status within the PCT, which does have statutory status.
Nevertheless, pathfinder consortia now cover around 90% of England, and many are still eager to take on responsibility.
David Thorne is chief executive of Newcastle Bridges Commissioning Consortium, one of the pathfinder groups. Unusually, Thorne is an ex-pharmaceutical industry man, having previously worked for Pfizer and Sanofi UK in a market access role.
He says consortia have spent the last few months struggling to find the right framework to work in. It now looks like events have already overtaken the move, and an alternative solution will have to emerge in many regions.
The plan was that consortia would be given direct financial responsibility for their area by becoming a PCT sub-committee, as currently they have no legal or financial powers as pilot groups.
Thorne said it was important that the sub-committees were created in order for consortia such as his to demonstrate their ability to handle budgets responsibly.
“It is difficult to show authority without delegated power from PCTs, so we need this in order to prove ourselves,” he said.
However, some of the most advanced local groups have already made the sub-committee plan a reality.
The GP consortia pathfinder in Kingston in Surrey was given delegated commissioning responsibility in April 2011, and is now making commissioning decisions via a GP committee reporting to the Kingston PCT board. Dr Naz Jivani, joint lead of the Kingston GP pathfinder, said in a media statement: “This is a positive step for the commissioning of health services in Kingston and we’re delighted that Kingston can continue to lead the way in implementing changes to NHS commissioning.
“Our focus will be on using our first hand knowledge of patients’ needs to commission the right care in the best setting.”
No ‘crude cuts’ to the drugs bill
As an ex-pharma industry executive, David Thorne has a sound understanding of prescribing budgets, and says they would be top on his consortium’s list of priorities to review.
“I think primary care prescribing is the most obvious area for a consortia becoming a new PCT sub-committee member to take on,” he said. “This is because GPs are the ones writing out prescriptions and always have been – to take on the budget is a natural evolution.”
He rejected the idea that his consortium was there to squeeze the drugs bill. “Would I like to wake up tomorrow and see all drug prices cut by a half? Of course, but this is out of my hands.
“We can’t have any say on drug prices, but what we can do is use a drug to its full potential in order to get the best value for money from it.” This is very much in line with the health service’s QIPP policy – Quality, Innovation, Productivity and Prevention – that looks to make smart savings without resorting to swingeing cuts across the NHS.
“QIPP is the way forward – it cannot just be about crude cuts to the drugs bill or to services; I truly believe that we must invest to save.
“I’ll give you an example: a few years ago we created a COPD project that saw us increase our PCT’s prescribing budget by a five-figure sum that translated into a saving of £125,000.
“We have 10,000 people under our practice and from that we have 100 admissions per year for COPD. By spending a bit more on a well-known COPD drug than was originally planned for, we have halved these admissions to 50.
“Each admission cost £2,500 per patient, so if you do the maths, you can see that we have saved our area £125,000, all from that small increase.”
This is the definition of QIPP, Thorne says, and the way in which his consortium is looking to make smart savings in the future.
“The opportunity is there for pharma; they need to come to us and tell us why their drug is worth the money – if they can, we are more than happy to pay for it when we know can make savings through that investment.”
Bridges pre-empts reform changes
The Newcastle Bridges Consortium had anticipated many of these developments, says Thorne, and he says it is well placed to adapt to the new CCG model.
One example of this is the new emphasis on ‘integrated care’ – something which Newcastle Bridges says it already has in place as one of its aims.
Newcastle Bridges currently has a practice board comprising two members of each of the consortium’s 16 practices, but unusually also has an elected community board, encompassing independent healthcare workers from the community, nurses, charity workers and other specialists.
This means that decisions are made by a plurality of people and Thorne believes this is more beneficial to his consortium than being purely GP-led. “When we have to make a decision and tell our community about it, having more people involved gives us legitimacy as we are made up from community members,” he said. But many other consortia may have trouble implementing such a system within their own groups, Thorne says.
“There is a reluctance from some GPs [to have more independent members] and they need to reflect on this in order to allow greater involvement in the decision-making process.”
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