A survey of GP pathfinders show consortia are taking very different approaches to new commissioning arrangements. While some are looking only to the NHS for support to preserve the "organisational memory" of the NHS, others are turning squarely to the private and voluntary sectors.
The survey of 25 GP pathfinder consortia, conducted by GPs magazine, Pulse, found that 11 of the new consortia had been involved in discussions with private and voluntary organisations and another seven had already signed deals in areas including back-office functions, tendering and accounting.
Although the first wave of GP commissioning consortia was announced in December, the survey found that a number of pathfinders, including East Suffolk Federation and Hunts Health in Cambridgeshire, have set up as private companies and others as social enterprises.
However a spokesman for the Department of Health said the consortia would not be allowed to continue as private enterprises when they take over from Primary Care Trusts and Strategic Health Authorities as statutory bodies in 2013.
Guy Pilkington, chair of Newcastle Bridges, one of six GP consortia planning only to use NHS managers across seven areas of support, said: "For any management support we're looking to NHS staff. There is an organisational memory we must not lose."
But Peter Patel, chair of South Birmingham Independent Consortium, said they would use external sources "on a federated basis", to reduce financial risks and build efficiency: "The existing NHS structure is an old model which is inefficient. We need to take a reality check," he said.
Another three said they were planning to outsource in at least six of seven areas and half of the consortia said they planned to look to external support for HR and around a third said they would do so for accounting, data analysis and back-office support.
The majority of consortia said they had already issued guidance to practices on efficiency savings and while over a half said they would break even under the new system, around a fifth said they were in danger of falling into severe deficit without major structural change.
"The government did always claim it would take a bottom-up approach to GP commissioning, and the wide variation in approaches being taken suggests it has been true to its word," says Richard Hoey, editor of Pulse.
"But the results also highlight the gulf that is starting to open up between the business-minded and entrepreneurial GPs who are leading some of these commissioning groups, and the grassroots who tend to be much more sceptical of involvement of the private sector."
The magazine highlighted the risks of commercialisation and postcode lotteries.
A DH spokesman highlighted cost savings and efficiency in the new system. "GP consortia should be able to get the best support they need to improve services for patients, whether it is from the public, voluntary or independent sector," he said.
"PCTs spent over £300m in one year alone on external consultants. That was in addition to the vast increase in the number of managers. We are cutting back on management costs by 45%, ensuring that more money is spent on patient care and that functions are not duplicated by external organisations.
"Every penny saved from efficiencies will be ploughed back into patient care."