Which GP consortia will you be in? – by Andy Kliman

As I’ve mentioned a few times before, and I’m sure you are already aware, the Government is planning a massive reorganisation of the NHS. One of the key changes is that GPs will be banding together into groups to manage the costs of our care, otherwise known as commissioning.

These groups, known as consortia, will be run as businesses and will be held accountable to the Government for the state of their finances. It is yet unclear if they will be able to make profits from managing their businesses successfully, but one would think that might be the incentive. Carrot and stick.

My point has been that diabetic patients, and others with long-term conditions, represent a bigger risk to the budget of these consortia because they are more likely to end up in the hospital than others – and this costs money. So too many diabetics on your books (GP lists) could be costly.

David Stout, director of the Primary Care Trust Network (the current group of commissioners), was reported in the Guardian (March 31 2011) as saying: “I am sure there will be concern about some [consortiums] being the equivalent of ‘sink estates’, with all the most difficult practices, [and] most deprived populations, coming together.”
The Guardian also quoted Frank Atherton, of the Association of Directors of Public Health, who said, “some consortiums could end up “cherry-picking healthier populations” and that “the more deprived and less affluent people [may] get left behind with the poor performing GPs”.

I raised this issue with David Stout at a recent talk I went to and suggested to him this sort of ‘risk modelling’, as it is known, could lead to a two, three and even four tier GP system. Consortia are not bound by geography but by relationships. So two GP Practices at either end of the same road might not get on and chose to be part of different consortia.

Or worse, two might apply to be in one consortia and one will get in and the other won’t based on the potential costs of the patients on their lists. I asked David, and others how this can be avoided and short of the suggestion that the Government would monitor this to try to stop it happening, no one could give me a real answer. I guess David is now concerned about this too.

In theory you don’t have to stay with your current GP, but is your current GP the best one or the closest one? Given that we still don’t have any information on how good GPs are, relative to each other, I’m guessing you are with your closest GP – I am. Will we know which Consortia they belong to or how well that consortia performs? Unlikely! Will we know if that consortia has run out of money towards the end of the financial year and therefore decides you don’t need that surgery or appointment for a few weeks, maybe a month? Again unlikely?

In order to track all this we need all this information to be made available to the public. The Government might well do this and has announced a new Transparency Tsar to help drive this through. I have every faith he’ll try, but the Government machine is slow and can be obstinate. I wish him, and all of us, good luck.

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Thanks for your very pertinent blog. I’ve pondered this issue ever since the Government’s plans were announced and am yet to hear a satisfactory answer. I’ve had issues with GPs in the past – what is it going to be like when it is their own or their own consortium’s money at stake? Where is the incentive to take on patients with chronic conditions?!

I am very worried, for many reasons, about the changes being made to the NHS but mostly because my daughter has Type 1 Diabetes. Our GPs are very good and I would find it difficult to criticise them in terms of the medical care they provide for my whole family. What they don’t have, and what I don’t expect them to have, is specialist knowledge about diabetes care. Yes, we had a battle about repeat prescriptions when my daughter was first diagnosed four and a half years ago, which led me to coin the phrase, “The NHS, free at the point of begging.” On a recent visit to the GP I showed her the pictures on my phone (taken to answer friend’s queries) of my daughter’s insulin pump, infusion set and silicone cannula, and explained to her how it all worked. Our team at the hospital are excellent, they have knowledge of the latest developments and they applied for the funding for the life enhancing pump. Is my daughter’s care going to be compromised? Does the funding for the pump and the costly supplies shift to my GP, the non specialist who doesn’t know how it works? These are the sort of questions I don’t have answers for.