Derbyshire GP consortia: information and options

1. Derbyshire GP consortia: information and options GP Commissioning Transition Committee November 2010

2. Aims • Further detail on financial risk; PCT function; corporate costs; etc • Options for possible future forms for GP Commissioning Organisations • Criteria against which these options could be assessed & initial analysis • Process and timeline to make a proper ‘bottom up’ decision

3. Information: financial risk • Variation and therefore risk, works on a square root calculation i.e. a four fold increase in population results only in a two fold increase in risk. • Approximate risk/ variation: 10k population = 19% variation; 50k = 8%; 100k = 6%; 500k = 3%; 1m = 2% • Higher cost procedures = higher risk • Risk can be offset in three ways: • Increasing the population covered • Capping the cost of any single event • Restricting the procedures commissioned by size

4. Current financial risk • All but two consortia overspent in 09/10 (Bog & Limes) • All overspent on historic budget • All but three consortia predicting overspend in 10/11 • September 2006 – 4 of 6 old PCTs in deficit (all but Chesterfield & North East)

5. Corporate function & costs • First draft PCT prospectus by department • High level costs by directorate • Estimate of GP leadership: pool of 20-30 GPs for a consortium? • Current PBC funding £1.90/head (£1.4m); already 20% of total funding?

6. Geographical options Option 1 a) A whole County GPCC including Derby City PCT b) A whole County GPCC excluding Derby City PCT  Option 2 • Separate North and South Derbyshire GPCC with the South including Derby City • Separate North and South Derbyshire GPCC with the South excluding Derby City  Option 3 • Multiple (6-10?) small GPCC around the County and City

7. Larger consortia description • Umbrella organisations comprising semi-autonomous localities & holding statutory responsibility • Localities take responsibility for all they can, delegating up where appropriate • Consortia could determine structure, size of localities and level of responsibility • Could be north/south; Derby City in or out • Could be interim arrangement, hosting localities that ultimately spin off - stand alone/cross border

8. Smaller consortia description • Stand alone statutory organisations, pooling risk with other organisations • Minimum size undefined but financial risk, clinical capacity, management funding and corporate overheads - at least 100k? • Develop lead commissioner roles for contracting and links with Local Authorities

9. Options appraisal: large v. small

10. Management options Option 1: Consortium employs most staff & does tasks in house. PCT staff would be eligible for TUPE Option 2 PCT staff set up stand alone commissioning organisation & GPCC contract from them Option 3 GPCC contract to private sector for functions  Option 4 A mix of any of the above as desired by GPCC

11. Process moving forward • GP consortia chairs to take the options back to consortia – return with initial view to December’s meeting • A one day symposium with Consortia Chairs & others • Continued LMC events • Transition Committee to feedback their consortia’s preferred option in December to provide context for; • Wider GP community vote on preferred option in January 2011 • Set up a small project team to implement work • Continue work on public & LA engagement • Agree management support funding for consortia for 10/11, devolve PBC engagement fund £1.90/head as real budget • GP pathfinder/s established to ‘fast track’ within overall health community plan