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

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

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

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)

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

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

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

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

Options appraisal: large v. small Clinical Ownership More remote, but localities mitigate Better sense of ownership? Financial riskEasier in houseWorse; federate? CapacityMore availableMore interest? CommissioningSignificant cloutCould federate Cost effectiveBetter if efficientMore focus FeasibilityEasier by AprilMore complex

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

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