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I am concerned about consortia taking on debts from the PCTs. Are these debts merely “notional” or are they real? What happens to consortia who may not be able to cope with debt and subsequently collapse? Could GPs have any personal liability? If a consor


31 March 2011

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The July 2010 White paper sets a three year timetable to
devolve commissioning budgets to GP Consortia and to phase
out PCTs. The actual consortium budgets are not expected
to be available until 2013 and we do not as yet have any hard
facts as to whether any PCT deficits are to be reflected in these
budgets. It is anticipated that some consortia may be faced
with taking over the PCT’s deficit and if this is the case then
it will be important to review how the deficit arose and over
which years and whether the problem is potentially ongoing.

The July 2010 White paper sets a three year timetable to
devolve commissioning budgets to GP Consortia and to phase
out PCTs. The actual consortium budgets are not expected
to be available until 2013 and we do not as yet have any hard
facts as to whether any PCT deficits are to be reflected in these
budgets. It is anticipated that some consortia may be faced
with taking over the PCT’s deficit and if this is the case then
it will be important to review how the deficit arose and over
which years and whether the problem is potentially ongoing.
If the problem relates to existing PCT contracts which have to
be honoured, then this could give rise to a potentially ongoin
g deficit. However, the consortia will have to investigate ways
of achieving savings through the redesign of patient pathways
and local services. It is intended that clinical decisions and
their financial consequences will be brought together through
GP commissioning and although this might help to eliminate unnecessary referrals, it will undoubtedly also give rise to some difficult conflicts of interest.

It is intended that savings will be made in the transition
years before the PCTs are finally abolished and the consortia
take on full financial responsibility in April 2013. This is to be
achieved through the existing Quality, Innovation, Productivity
and Prevention (QIPP) initiative and there is certainly a strong
incentive for GP consortia to work towards making savings in
this period to reduce any deficit which the consortia could be
responsible for taking over.

The White Paper specifically states that there will be no
bail-outs for organisations which overspend public budgets
so consortia will have to work within the set budgets and
manage financial risk. The set budgets will not only relate to
commissioning services but also to the management allowance
allocated to each consortium. We will have to await the details
to be published in the Regulations before we know the
specifics of the failure regime for commissioners
We do know that the funding is to follow the patient on
a weighted capitation model, adjusted for quality. The NHS
Commissioning Board will calculate practice-level budgets and
allocate these direct to the consortia. The consortia will be
held to account for the stewardship of these NHS resources
and the outcomes they achieve as commissioners. There
will accordingly be quality increments for excellent care but
contractual penalties for poor quality care. The consortia in
turn will hold the GP practices to account so an element of
the practice income will be linked to outcomes achieved by
the consortium and will be subject to penalties and rewards.
The funding and accountability chart in the White Paper does
not extend to the level of individual GPs so it appears that
individual GPs will not be personally liable for overspends by
their consortium.

There is unfortunately still a lot of uncertainty until more
information is published regarding the robust economic
regulation referred to in the White Paper and this is followed
up in the Health Bill. The consortium will have a duty to break
even, but the NHS Commissioning Board, DoH and Treasury
are to agree whether planned and managed overspends can be
carried over and deducted from the following year’s budget.

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