Details about GP Consortia and Junior Doctor Training

Sir David Nicholson has written to various important people in the NHS to tell them about Commissar Lansley's plans. The document is available from the Department of Health website. Here are some pertinent points.

It is our intention that GP consortia would be statutory public bodies. We have said that 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.

GP practices already make a key contribution to the overall quality of patient care and to the effective use of NHS resources. We propose, subject to discussion with the BMA and the profession, that a proportion of GP practice income should be linked to the outcomes that they achieve collaboratively through commissioning consortia and the effectiveness with which they manage financial resources.

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. We 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.

Monitor would also have concurrent powers with the Office of Fair Trading to enforce Competition Law within the health and social care sector. These would be statutory powers that could be enforced outside of Monitor's licensing regime and could, therefore, be applied throughout the sector, including in primary care, and to all types of provider.

This looks like GPs will be subject to Competition Law.

The White Paper makes it clear that it is time to give employers greater autonomy for planning and developing the workforce alongside greater professional ownership of the quality of education and training. ... It would be set within the context of delivering appropriate investment in workforce education and training, whilst ensuring better outcomes for patients and value for money. It would also need to ensure appropriate checks, balances and accountability. The arrangements for education commissioning and delivery would be transparent and more efficient.

This seems to indicate that training will be the responsibility of hospitals. The "investment" part is important because at the moment training (and the salaries of trainee doctors and nurses) are paid by the Department of Health. The "investment" may indicate that individual hospitals will be responsible for this training cost. Considering that it costs £350k (or about 60 hip operations) to train a junior doctor this is not an insignificant cost. If doctors are made to shoulder this cost it would completely rule out any student from a low income background becoming a hospital doctor.