Training Blog

Some think that if the Conservatives win the next election they aim to make GP practices become practice based commissioners. This would mean that the majority of their commissioning functions would be carried through federations of GP practices that operate as consortiums. This proposal would mean a reduction in the commissioning role of PCTs in some areas.
Under the Tories:

• The merger of PCTs would be welcomed but not forced
• All GP practices would be expected to become practice based commissioners
• Trusts would be expected to negotiate prices for acute care at a rate under the PbR price
• The Conservatives would welcome such mergers as part of an organic process but stress they would be voluntary. They hope to encourage more GPs to take up commissioning by turning the currently indicative budgets into real cash budgets.

Shadow Secretary of State for Health, Andrew Lansley states that it would give practices real opportunities to save and reinvest. It would also give them control over contracts and how patients are treated. Lansley stresses that any underspends would remain for the use for patient care, not profits. Health project leader at the Social Market Foundation think tank, David Furness, said the implications of an enhanced role for practice based commissioning were “much more significant than has been [previously] discussed”.

When asked if the Conservatives wanted to see more such mergers such as those in London, the response was: “It would be perfectly reasonable to aggregate, but it will be up to them [PCTs] to decide. It would be done on an organic bottom-up way if [they] choose to do so.”

Within the NHS, sources who have been asked to advise the Conservatives on the development of their health policy, said they thought the party would ideally like to see strategic health authorities and PCTs merged to create maybe 40 strategic commissioning bodies, organised around city regions. It is thought that this would rectify the problem that PCTs are perceived as being “too small” to be able to negotiate good value from large acute hospitals.

However, a spokesman for the Conservatives denied that the party were planning to merge SHAs and PCTs, saying that it was “very clear that’s not what we are planning”. He does also add that they do foresee SHAs moving their focus away from providers as more become foundation trusts. However Tory leader David Cameron and Mr Lansley have pledged they will not subject the NHS to another round of structural reorganisation.