Liberating the NHS White PaperFrequently Asked QuestionsCommissioningAs GPs are currently independent practitioners, how would the Commissioning Board and consortia groups hold GPs to account for the delivery of key performance and financial targets? It is anticipated that GP consortia would be statutory public bodies. Each consortium would appoint an Accountable Officer and a Chief Financial Officer who would have responsibilities and accountabilities as leaders of their NHS organisations. However, beyond this the governance arrangements would be a matter for the consortia themselves to determine. The NHS Commissioning Board would also be responsible for developing an assurance process that would hold GP consortia to account for the outcomes they achieve, their stewardship of public resources, and their fulfilment of the duties placed upon them, for example in relation to promoting equality and working in partnership. It is proposed that the NHS Commissioning Board would develop a commissioning outcomes framework that measures the health outcomes and quality of care achieved by consortia. The framework would allow the NHS Commissioning Board to identify the contribution of consortia to achieving the priorities for health improvement in the NHS Outcomes Framework. GP practices already make a key contribution to the overall quality of patient care and to the effective use of NHS resources. Subject to the outcome of the consultation, the primary legislation would need to allow for the NHS Commissioning Board to also intervene in the event that a consortium is unable to fulfil its duties effectively, for instance in the event of financial failure or a systemic failure to meet the health care needs of patients., or where there is a high risk of failure. Would GP consortia be NHS bodies and NHS employers? GP consortia would be NHS bodies and NHS employers. The intention is that they would be statutory bodies, with powers and functions set out through primary and secondary legislation. The Department of Health (DOH) propose, however, that they would have flexibility in relation to their internal governance arrangements, beyond essential requirements for example, in relation to areas such as financial probity and accountability, reporting and audit. What plans are there to engage GPs with commissioning? The proposed model does not mean that all GPs have to be actively involved in every aspect of commissioning, but a fundamental principle is that every GP practice would be a member of a consortium, as a corollary of holding a list of registered patients, and would contribute to its goals. SHAs and PCTs will have an important task over the next two years in supporting GP practices to prepare for the new arrangements. There are a number of practical next steps that they will need to take with GP practices and existing practice-based commissioning groups during 2010/11, which we will be discussing with the NHS and professions. This will include identifying the likely future shape of consortia and enabling them to start taking increasing responsibility for making commissioning decisions on behalf of PCTs. PCTs would also need to work alongside shadow consortia to forge relationships with patient and public groups and with a range of external partners, including local and national HealthWatch, local authorities and local voluntary organisations and community groups. It is important to recognise that all General Practitioners would be commissioners, through their decisions on referrals and their involvement in a consortium. Is there room for non-medical staff to be on the consortia? There are non-medical partners in GP practices. A fundamental principle of the proposed new arrangements is that every GP practice would be a member of a consortium, as a corollary of holding a registered list of patients. Practices would then have the flexibility to form consortia in ways that they think will secure the best healthcare and health outcomes for their patients and locality. | 
