Organisational Development

The consortium structure should depend on what it is the consortium wants to do and achieve, subject of course to having a sensible geography and the ability to manage insurance and service risk.

Many consortia now wish to remain independent but share one risk pool and a mechanism for coming together to commission services with other local consortia (in to this we may also see them sharing one support team and the accountable officer). This is one of three main options; however, to get to a point of being able to make a decision on your preferred option the following needs to be agreed;

1. What the constituent practices are able to commission for their registered list (improve ‘make or buy’ decisions)
2. What the consortium wants to commission as a standalone organisation
3. What the consortium wants to commission on a local footprint (with other local consortia who share common providers)
4. What the consortium wants to commission on a larger scale, perhaps SHA wide
5. What the consortium wants to outsource

Once these questions have been answered a decision can be made as to what form/structure will best serve the outcomes the consortium wants to achieve.
 
At the same time, there is a limit to what you can do and in reality the three options, but not mutually exclusive are;
 
1. Remain completely standalone

a. Manage all insurance and service risks
b. Employ a support team
c. Commission as much as possible as a standalone organisation and jointly with other consortia where required

2. Remain independent as a consortium but pool with other consortia for risk and commissioning

a. Each contributes a % of indicative budget to a risk pool
b. Jointly employ a support team
c. Commission services together, but will still be able to commission services locally for your own patient cohort

3. Merge to form one large consortium 
 
There may be slight variations in these; however, this is the core of what lies ahead. At this stage there is no indication of how much money will be available for management costs and to employ the support team. Therefore choose the ideal structure and cost the work. This will then give you a picture of how much you need if you are to deliver the plans, and provide a start.
 
It is important to understand that there are benefits and risks for all options and all sizes of consortia. Risk is not necessarily managed through size alone, and with increasing size comes as many challenges as potential benefits. For example working at large scale should in theory be cheaper and more effective. In practice starting at scale has often been the problem for commissioners. Solutions designed with a big population in mind often fail to address the particular problems experienced at practice or locality level.