Changes to the Health and Social Care Bill: commissioning and primary care

The comparison below sets out the Health and Social Care Bill's initial proposals as regards commissioning and primary care, what has now changed and some key questions that remain unanswered.

The original proposals in the Health and Social Care Bill

  • 60 per cent of NHS budget to be transferred to GP commissioning consortia to commission the majority of local health services.
  • Commissioning consortia required to obtain advice from health professionals but wider clinical involvement in commissioning process limited.
  • All commissioning consortia to be in place and operational by April 2013. GP practices to be members of GP commissioning consortia as a condition of their ability to practise.
  • No requirement for commissioning consortia and local authority boundaries to align.
  • Primary care and specialist services to be commissioned by the NHS Commissioning Board.
  • Part of GP practice payments to be linked to quality premium based on performance of GP commissioning consortia.

What has changed in the reformed proposals?

  • GP commissioning consortia re-named clinical commissioning groups, reflecting requirements for wider clinical involvement in commissioning.
  • Clinical commissioning groups required to obtain advice from a wider range of health professionals and will be supported by clinical networks and new clinical senates. Governing bodies must include a nurse and a hospital specialist
  • Clinical commissioning groups to be established either in full or in shadow form by April 2013, but take on their new responsibilities only when they are 'ready and willing'. All practices still need to be members of a clinical commissioning group by this date.
  • Requirement that the boundaries of clinical commissioning groups should not normally cross those of local authorities, with any departure needing to be clearly justified.
  • Quality premium revised to focus on quality and outcomes and may take account of progress in reducing inequalities in health.

What is still unanswered?

  • Will the multiple lines of accountability and requirements to consult immobilise clinical commissioning groups?
  • Will clinical senates and networks be locally based sources of advice and support to clinical commissioning groups or outposts of the NHS Commissioning Board?
  • Will momentum be maintained or will the changes discourage enthusiastic GPs from leading reform at a local level?
  • Who will be responsible for driving major reconfigurations of hospital services?
  • Will the NHS Commissioning Board adopt a top down or locally led approach to quality improvement in primary care?
  • How will conflicts of interests be managed for GPs as provider and commissioners of services?