Briefing Paper P036 - Government NHS White Paper Proposals: Commissioning for Patients


As part of its work Hastings Voluntary Action have produced this briefing - as part of a series on the Governments NHS White Paper.

Devolving Commissioning Decisions to a Local Level

The Governments future framework for commissioning sees most activity being undertaken by consortiums of General Practioners operating under an NHS Commissioning Board who will assume responsibility for consistency and performance. Through this mechanism the Government believe that commissioning will be closer to patients and more free of bureaucracy.

The Scope of Commissioning Undertaken by GP Consortia

Consortia of GP practices will commission the great majority of NHS services on behalf of patients, including elective hospital care and rehabilitative care, urgent and emergency care (including out-of-hours services), most community health services, and mental health and learning disability services. A major exception is in the area of Health Improvement – the so called “life-style” commissions which will transfer to Local Authorities. Consortia will not be responsible for commissioning primary medical services, which will be the responsibility of the NHS Commissioning Board, but consortia will become increasingly influential in driving up the quality of general practice. The NHS Commissioning Board will also commission the other family health services of dentistry, community pharmacy and primary ophthalmic services, as well as national and regional specialised services, maternity services and prison health services.Consortia will be responsible for managing their combined budget and for deciding how best to use these resources to meet the healthcare needs of the patients for whom they are responsible. Just as PCTs are currently the responsible commissioner for people registered with a GP practice in their area (even if they live elsewhere), the consortium will be the responsible commissioner for any patients registered with its constituent practices.

The role of the NHS Commissioning Board

• provide national leadership on commissioning for quality improvement, for instance by developing commissioning guidelines based on quality standards and by designing tariffs and model NHS contracts
• promote and extend public and patient involvement and choice
• ensure the development of consortia and hold them to account for outcomes and financial performance
• commission certain services that are not commissioned by consortia, such as the national and regional specialised services
• allocate and account for NHS resources.

The number and size of GP Consortia

Surprisingly little information is given in the White Paper about the size or number of the GP Consortia every practice will need to be a member of one The paper states that they will need to have sufficient geographic focus to be able to agree and monitor contracts for locality-based services (such as urgent and emergency care), to have responsibility for commissioning services for people who are not registered with a GP practice, to commission services jointly with local authorities, and to fulfil effectively their duties in areas such as safeguarding of children. The consortia will also need to be of sufficient size to manage financial risk effectively,

Powers and Responsibilities

The Government propose that the NHS Commissioning Board, supported by NICE, will develop a commissioning outcomes framework so that there is clear, publicly available information on the quality of healthcare services commissioned by consortia, including patient-reported outcome measures and patient experience, and their management of NHS resources. The framework would also seek to capture progress in reducing health inequalities. As part of these arrangements Consortia will take part in the Health Partnership Boards and maintain relationships with stakeholders including

  • • local HealthWatch (currently Local Involvement Networks) and the national body HealthWatch England, the new independent consumer champion that we propose to establish as part of the Care Quality Commission
  • • the Patient Participation Groups that GP practices are increasingly using to help make their own services more responsive to patient wishes
  • • local authorities, who will have a new enhanced role in promoting public involvement in decisions about service priorities and changes to local services and in responding to any public concerns about inadequate involvement
  • • local voluntary organisations and community groups, who often work with, and represent, the most disadvantaged and marginalised patients and carers.

Timetable for Implementation

In 2010/11
• GP consortia to begin to come together in shadow form (building on practice-based commissioning consortia, where they wish)
In 2011/12
• a comprehensive system of shadow GP consortia in place and the NHS Commissioning Board to be established in shadow form
In 2012/13
• formal establishment of GP consortia, together with indicative allocations and responsibility to prepare commissioning plans, and the NHS Commissioning Board to be established as an independent statutory body
In 2013/14
• GP consortia to be fully operational, with real budgets and holding contracts with providers.
A full downloadable copy of the consultation paper can be found via the Department of Health website:-

Responding to the Consultation

Responses to the questions in this consultation document should be sent to or to the White Paper Team, Room 601, Department of Health, 79 Whitehall, London SW1A 2NS by 11 October 2010.

Group Support: