We are only two months away from it becoming real for GP consortia. I was looking through the information going to one of our pathfinder executive meetings in the next week. The GP consortium is looking good for this year and will deliver within budget unless something unexpected happens.

Buried within the report was some worrying detail. The predominant reason they will be ok this year is because of factors beyond their control. Elective activity is below expected levels and that is something I know our acute provider wants to remedy! In contrast, outpatient referrals are well up and prescribing is overspent against plan. The order book is building, emergency activity is not diminishing, and all the indicators suggest the consortium could be heading for over trading in 2011/12. more…

As we wrestle with uncertain futures, financial stringencies, and retaining a focus on ensuring services continue to get delivered, there is a creeping realisation that something is missing.

There is a bill before Parliament which details, in jargon that defeats me, the changes to the structures for commissioning. It lays out the way the system will be regulated and steered towards the new dawn. At its heart, at the core of this radical change, is the premise GPs will be willing and eager to pick up the challenge being laid at their feet. Why will they?

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I am lucky because I work with a Director of Finance who likes to make things clear and easy to understand. Last week he went through what is happening to the money for 2011/12. He wanted to help my team, well all of us really, understand where the money has gone. more…

In Lincolnshire, we had 3 Pathfinder consortia announced in the second wave. This is good news. At least, we think it is. We are, however, not sure what being a “Pathfinder” means.  It would appear to mean that GPs are enthusiastic about the reforms and taking up the challenge. Is that true? more…

There are a number of variants on the cartoon about an alien asking someone or something to “take me to your leader.” Of course we all laugh because we can see the alien doesn’t realise they are approaching the wrong person or thing. Now, there is a new version being played out between PCTs and consortia and it is no laughing matter. Who is the leader in a newly formed consortium? What mandate and authority do they have? more…

I have a weekly teleconference with GPs from our emergent consortia. We set this up a while back to try and keep up with events, nix rumours and misconceptions and, collectively, try and make sense of what is going on. 

Over the last few weeks a lot of work has gone into developing a draft transition plan. This needs to be owned by our Board and by the future consortia. Discussing this, I said to my GP colleagues that we were getting early indications that the centre (the collective noun for a multitude of people who know exactly how ‘it’ – insert any task that comes to mind – should be done) were going to expect each and every consortium to have its own transition plan. more…

This is one of the busiest times of the year for the PCT. We have a tight timetable to assemble a plan and start contract negotiations. Soon we will be given an operating framework. We are given a lot of central direction and this year part of that is called QIPP; we have to have a QIPP plan. more…

The concerns expressed by the new chair of the RCGP about the difficulties which GPs might face, in taking on commissioning, are pertinent. There is always a tension between being the advocate for the patient in front of you and for the population behind them. It does seem odd that PCTs have been exhorted to divorce themselves from provision over the last few years and yet, here we are, laying the job of commissioning at the door of a group of clinicians who are wholly inexperienced and untrained to do it. In a recent conversation with some GPs, they told me that they were confident that they could do a better job than the PCT because they would get rid of bureaucracy.  I queried what they thought they could dispense with? more…

The King’s Fund paper “How cold will it be?” published in July 2009, discussed three financial scenarios for the NHS. The toughest was a 2% reduction in funding for 3 consecutive years. Of course that hasn’t happened, has it? The comprehensive spending review protected the NHS with a 0.1% increase, an option described in the paper as “cold.” more…

We did something a bit different today as an executive team. We used the “goldfish bowl” technique to explore how to support the transition from PCT-led to Consortia-based commissioning. I apologise if you already know what this technique entails. For those of you who don’t; we put four chairs in the middle of a circle of chairs with three people seated on them, who kicked the discussion off. If you wanted to contribute you could take the spare chair, but someone had to then vacate a chair and join the outer circle. The idea of doing this came from one of my assistant directors who is on the Generation Q programme. It worked really well. We all had to listen. Getting up to join the central trio signalled and prepared everyone for a contribution. more…