Here’s a simple question about the NHS reforms: who’s going to count the beans? Bean counting gets a bad press, but as soon as someone fails to count the public sector beans – for which read "taxpayers' money" – properly all hell breaks loose.
So imagine how surprised I was to hear a Tory MP say that GP consortia were already set up in his constituency and raring to go – they wanted to take over today! Really? If they do it shows just how unfit for the job they are.
There are indeed lots of GP consortia – my GP has been part of one for ages. But as far as I know none of them has direct control over the commissioning finances yet and, rather more to the point, none of them has a financial system capable of doing the job either.
At the moment all finances are still channelled through the systems of primary care trusts. If GPs do take over £80bn, as is constantly cited, and there are 1,000 consortia (it’ll probably be fewer) then each of them will have to have a financial system capable of handling £80m a year. At the moment, this money flows through the PCTs’ financial systems.
Presumably every GP consortium will have to have its own financial system and in the spirit of these ‘letting a thousand flowers bloom’ reforms, I also assume they can choose systems and suppliers for themselves?
The only alternatives – with strategic health authorities and PCTs gone – would be either to have a centrally imposed, one-size-fits-all system or for the Department of Health to manage all the finances centrally, with consortia just making the decisions about where the money goes. That would seem unlikely.
So how and when will the new consortia’s financial systems get into place? They cannot even be specified until (a) the legislation is passed; (b) it is turned into detailed guidance about how consortia have to manage the money (there will be rules); (c) the consortia are established and decide what they want. Only then can they even start the process of commissioning a bean counting system.
No wonder Health Secretary Andrew Lansley has taken the opportunity of a ‘natural break’ to review the legislation – regardless of the politics, the sheer practicalities of changes on this scale mean it is highly unlikely to be done successfully on the current timescales.
Of course, I may be wrong. It wouldn’t be the first time. So if anyone knows that there is a plan out there that will allow all these consortia to handle the £80bn please do tell.
Oh, and one last thought – who is going to audit them?
Colin Talbot is professor of public policy and management at the University of Manchester Business School. This post first appeared on Whitehall Watch
