Giving GPs budgets for commissioning: What needs to be done?

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The new coalition government has made clear its intention to 'strengthen the power of GPs to act as patients' expert guides through the health system', by enabling them to commission care on their patients' behalf (Cabinet Office, 2010).

This briefing paper has been developed jointly by six national organisations: Nuffield Trust, The King's Fund, NHS Confederation, NHS Alliance, National Association of Primary Care and Royal College of General Practitioners, who have been working together over a number of months to explore what needs to happen if GPs are to be given real power and responsibility for leading commissioning in the NHS.

We believe the following are some of the most critical issues to be resolved in creating what we have termed 'GP commissioners':

  • Recognising that the term 'commissioning' encompasses a wide range of specific activities, so a 'one size fits all' solution will not work.
  • Determining the appropriate population size for GP commissioning groups and how a fair budget can be set, together with establishing the range of services to be included.
  • Clarifying how budgets will be allocated to GP-led commissioning groups, who will hold them to account, how their performance as commissioners will be assessed and managed and how patients and the public will be involved.
  • Establishing what it means to hold a real commissioning budget, and the appropriate blend of associated risks and incentives.
  • Determining whether a minimum level of involvement in certain aspects of commissioning should be mandatory or voluntary.
  • Ensuring that the particular potential of GP budgetholders in developing extended primary and community services is harnessed, while managing conflicts of interest and maintaining competition and choice for patients.
  • Finding ways of engaging specialist clinicians alongside GPs in budget-holding and commissioning, in particular in reshaping urgent care and the management of long-term conditions. This includes reviewing the existing payment mechanisms, incentives and contracts that shape current specialist practice.
  • Ensuring that GP leadership is supported and developed in a context of significant reductions in management costs and potential cuts in training budgets.
  • Developing a powerful and convincing narrative to explain how GPs can both focus on individual patient needs and take responsibility for wider population health and funding.
  • Effectively managing the transition to the new arrangements in a way that ensures a focus on quality improvement and rigorous financial control is maintained.