Martin McShane: Transition and the operating framework

Martin McShaneI 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.

“How can we have a transition plan when we don’t know what our functions are, consortia don’t properly exist yet and we don’t where we are transitioning to?” retorted one GP, to which I had to suppress the reply, “You might well think that; I couldn’t possibly comment.”

However, later in the day the operating framework was published and Sir David Nicholson was appointed chief executive of the future NHS Commissioning Board. On the Today programme, that morning, Evan Davis memorably described the operating framework as “the NHS’s to do list.” If you go to the annex you can see part of that “to do” list. There are 29 headline measures with well over 60 supporting measures on which we will be performance managed. It is, however, in reading through the framework that the real scale of the transition facing PCTs becomes apparent.

Within two years PCTs must:

1. Establish, develop, and have authorised, as statutory bodies, GP consortia
2. By June, in many parts of the country, merge the management of two or more PCTs
3. Establish new financial relationships with local authorities to hand over millions of pounds of NHS money
4. Arrange to transfer substantial public health functions into local authorities
5. Support and engage consortia in the establishment of health and well being boards
6. Support engagement between the NHS commissioning board and consortia
7. Begin the process of establishing new organisations to deliver the commissioning support for consortia in the future
8. Deliver the QIPP agenda
9. Continue to respond to all the reporting requirements from the centre.

This is daunting. My concern however is that it is all irrelevant unless we make sure that patient care is not damaged in all this kerfuffle.  To do that, in my mind, requires the whole scale engagement of our GP leadership and community, in maintaining the quality of services and financial balance. So will they engage?  I draw your attention to a particular paragraph in the operating framework:

5.10 GP consortia will have their own budgets from 2013/14. They will not be responsible for resolving PCT legacy debt that arose prior to 2011/12. PCTs and clusters must ensure that through planning in 2011/12 and 2012/13, all existing legacy issues are dealt with. During this period we expect developing GP consortia to work closely with PCTs to ensure that financial control and balance is maintained to prevent PCT deficits in those years.In other words, from April 2011 GPs are completely dependent on closely collaborating with PCTs unless they want to inherit a financial deficit in 2013.

I think the next teleconference is going to be a busy one!

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.