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GP consortiums must learn from US experience, says expert

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d3720 (Published 13 June 2011) Cite this as: BMJ 2011;342:d3720
  1. Nigel Hawkes
  1. 1London

GP led commissioning in England could lead to financial crisis for many consortiums if US experience is ignored, an American expert advises.

Lawrence Casalino says in a report for the healthcare policy think tank the Nuffield Trust that, of 1500 doctor led networks and groups set up in the United States, only a 10th proved successful at managing the financial risks of commissioning.

Many failed, and some went bankrupt, for a mixture of reasons. These included too little focus on the management and infrastructure needed to handle the financial risk; a lack of clinical leadership; resentment among patients that family doctors were acting as gatekeepers to care; an inability to stand up to the tough negotiating stance adopted by hospitals and specialists; and shrinking budgets imposed by insurers.

The US networks, called independent practitioner associations (IPAs), are the closest international parallel to the …

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