There are no particular surprises about the proposals for commissioning consortia. Each consortium will be a legal entity, each GP practice must be a member of a consortium and each consortium will have a constitution.
The Bill makes no statements about the number or size of consortia. Instead the Bill allows for flexibility. It will be possible to have a consortium consisting of just two GP practices. The only requirement is for the NHS Commissioning Board to ensure that commissioning consortia cover the whole of the country and do not overlap.
Consortia are to be established by way of application to the NHS Commissioning Board. The Bill simply prescribes that the application must name the proposed commissioning consortia’s accountable officer, include a copy of the constitution and include such other information as the board may specify in the future.
Constitutions are a relatively new concept for NHS bodies, first introduced for foundation trusts. Schedule 2 of the Bill, sets out the information to be included in a constitution. This is the name of each commissioning consortium, the geographic area it covers, its corporate governance arrangements, including decision making procedures. None of these requirements are surprising or controversial. What is notable is that the wording of the Bill is permissive and not prescriptive, leaving consortia to decide their size, membership and governance structure. For example, there is no requirement on a consortium even to have a board – although it is not easy to see how decision making will be carried out without one.
The two prescriptive elements for the constitution are that each consortium must state how it will deal with conflicts of interest and how it will ensure each member effectively participates in the consortium. These more detailed provisions address the risk of consortia simply giving contracts to members’ practices and undermining the Government’s drive towards greater competition in the health market. They also place on consortia the responsibility of ensuring each GP practice is involved in the exercise of its consortium’s functions.
The Bill is far more detailed regarding the obligations of commissioning consortia or as they are named their duties. These include securing continuous improvement in the quality of clinical services and in the outcomes achieved from the provision of such services. Although these duties are qualified in that commissioning consortia must exercise their functions with a view to achieving improvement in quality and outcomes, these are nonetheless obligations which, if not achieved, expose commissioning consortia to legal action.
Similarly, in exercising their functions, commissioning consortia must have regard to the need to reduce inequality between patients in accessing health services and in the outcomes experienced by patients. Commissioning consortia will need, when developing commissioning plans, to demonstrate how these obligations are taken into account.
The NHS Commissioning Board has similar obligations to exercise its functions with a view to achieving improvement in quality and outcomes of clinical services. Interestingly commissioning consortia must assist and support the Board in achieving this in respect of primary medical services. Quite what is expected of consortia here remains to be seen. What the Bill does is provide a framework within which a degree of responsibility for GP services falls to consortia.