News / HFMA urges rigorous tests of consortia financial capability

The HFMA has called for robust assessments of GP consortia before and after they are authorised and warned of the danger of losing key finance staff in its response to the Liberating the NHS white paper and associated consultation papers.

The association’s response said the reforms must include pre- and post-assessment of GP consortia’s capability and capacity to manage significant levels of resources and to commission effectively.

Annual assurance of financial management, reporting and internal control was needed to assure the public that funds were being spent effectively and to drive improvements. The Department said a decision on the management and ownership of the primary care estate following PCT abolition would be announced this autumn.

The HFMA welcomed the government’s commitment, made in the Commissioning for patients consultation paper, to give the proposed NHS Commissioning Board powers to authorise consortia. The paper said the board would authorise consortia when satisfied they could fulfil financial accountability and control duties.

The HFMA said: ‘It is essential that the initial registration process is itself stretching and robust and that it is maintained using an objective measurement system that looks at performance each year and makes the results public. In our view, the approach adopted should build on learning from the foundation trust authorisation and regulation process.’

It warned that the ability to deliver the required £15bn-£20bn of savings could be threatened and control in general weakened if the finance function was cut too far.

The association also said the number of consortia would be key to management costs in the new structure, but was ‘doubtful’ that replacing 152 PCTs with about 500 consortia – the number often suggested as under consideration – would lead to management savings.

It added that a mechanism was needed to retain skills in commissioning and finance that had built up in strategic health authorities and primary care trusts.

The HFMA’s response was submitted to the Department of Health as health secretary Andrew Lansley revealed more detail of the governance arrangements for the new commissioning bodies. In a letter to GPs, he said consortia would have flexibility on internal governance arrangements with one exception.

‘There is no expectation that consortia should resemble PCTs in their own structure. We intend that only essential requirements, such as financial accounting, are set out as statutory duties.’

The letter, which is thought to be unprecedented, sought to inject pace into preparations for reform, which seemed to be losing impetus. Surveys of GPs in September showed a drop in support for the government’s reforms since July.

Mr Lansley urged GPs to get involved in forming consortia now and PCTs to use existing powers to devolve commissioning decisions to groups of GPs and other clinicians. The proposals would not burden them with paperwork, nor would they be expected to be involved in the minutiae of managing commissioning decisions. Membership of a commissioning consortium would not make individual GPs financially liable for any overspends.

Consortia would be supported by the Commissioning Board, while a management allowance would allow them to buy support. Mr Lansley insisted the level of management allowance would not be set until after the consultation period and would depend on the duties given to the new consortia.

‘There are many responsibilities currently placed on PCTs that we propose will not be placed upon consortia,’ he wrote. ‘We envisage some responsibilities will transfer to local authorities, or to the NHS Commissioning Board, and that others may be scrapped entirely.’

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