How will primary care groups work?

Abstract

Delivery of the 10 year strategy for health set out in the white paper will depend to an important degree on the effectiveness of the new primary care groups in delivering local health improvement programmes, in partnership with health authorities. From April 1999, 500 new primary care groups, typically serving populations of 100 000, will replace nearly 4000 existing commissioning organisations, including general practice fundholders. They will be resourced out of current fundholding allowances. Primary care groups will involve all local general practitioners, along with community nurses. The white paper outlines four progressive forms of primary care group: giving advice to health authorities on commissioning; managing devolved budgets; independent primary care trusts responsible for some devolved commissioning; and primary care trusts responsible for commissioning all primary and secondary care services with a fully integrated budget. It is not yet clear how primary care groups will relate to optometrists, pharmacists, or dentists. For the first time, primary care budgets will be fully cash limited, but groups will be able to move money between different parts of the service to balance their books. Although national standards will be set to ensure fair access to services and uniform quality, the planning, commissioning, and delivery of services will be local responsibilities. The fully developed model looks much like an extension of total purchasing, with the addition of fully integrated primary and secondary care budgets-not unlike an American health maintenance organisation. Primary care groups with trust status will be managed by a board consisting of general practitioners, community nurses, managers, social services representatives, and lay members. Will the new system work, and will it represent an improvement on what it replaces? The success of primary care groups will depend largely on two issues: engaging the support of people in primary care, and demonstrating local accountability and control of decision making.

Chronically ill Canadians’ experiences of being unattached to a family doctor: a qualitative study of marginalized patients in British Columbia

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Practice based commissioning: applying the research evidence

“…General practitioner fundholding (and other models of primary care commissioning) represented an opportunity for clinicians to assume power and influence previously the preserve of managers, but this power was typically distributed unevenly among doctors 15 19. Others have suggested that an important incentive within fundholding and total purchasing was the freedom to produce change and try to improve services, particularly if, in the process, there were benefits for practices themselves 20. Much sharper incentives will now be needed to engage all general practitioners in taking on budgets with the aim of improving services, maybe linking part of their income with the responsibility to manage a budget.…”

“Functional localities: an integrated spatial approach towards health care locality definition”

“…Recent trends towards decentralisation in the NHS have been influenced by wider political and social policies, such as devolution in Scotland, Wales and to a certain extent Northern Ireland. The evolution of primary care led purchasing, with the market style approach of fundholding and the development of Primary Care Groups and Trusts, has developed an increased impetus towards a primary care led NHS and the provision of such care at the locality level (Butler and Roland, 1998;Chisholm, 1998 andMunro, 2000). This shift in resources from the secondary sector to primary care ensures the expansion of intermediate care at the primary level and decision making closer to the 'consumer'.…”