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Sticky questions for the NHS


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Friday, 22 October 2010

Sticky questions for the NHS

Delegates to this week's NAPC conference appeared broadly optimistic about the challenges facing GPs in the next two and a half years.

There were one or two rants from backbench GPs of the shouty kind, but to judge from the turnout in Birmingham, the new breed of commissioners are by and large up for it.

Among the stickier questions, was this one from a GP who inadvertently set the theme for the event.

"We were very optimistic about fund-holding and we know what happened to that. We were extremely optimistic about practice-based commissioning until PCTs up and down the country poured huge amounts of treacle on our optimism. Do you see more treacle in the future and if so where is it going to come from?"

The question was to Dame Barbara Hakin, managing director of the NHS commissioning board, who showed little appetite for a debate about pudding. "There isn’t going to be that much treacle," she explained.

Why? Because this time GPs would be in control of budgets, commissioning plans and everything else. Any sticky stuff would be purely of their own making.

It was hard to tell whether GPs believe that it really will be up to them in future, but the speakers clearly felt that they still need convincing.

Sir David Nicholson, the NHS chief executive, acknowledged that the DH had form when it came to devolving power one day and seizing it back the next. This time would be different, he insisted.

Andrew Lansley, the health secretary, went over some familiar ground about the opportunity for the NHS to get away from its obsession with inputs and processes and focus instead on outcomes for patients.

The secretary of state also made clear that his interest in quality is inseparable from concerns about productivity and value.

"It is not professional in my view to ignore the consequences of the decisions you make," he said.

The health secretary's subtext is that the new freedoms are a straight trade for old style NHS management structures and interfering government departments. You get the former only if you agree to give up the security blanket of the latter.

GPs have become accustomed to being loved by the public. The prospect of risking that affection by putting themselves at the centre of difficult commissioning decisions, and the sudden absence of the scapegoat layer of management are among the most difficult challenges they face – far more difficult than the sterile technical issues around organisational form and governance.

As one GP put it, the central issue is that "There is no longer a them. Them is now us."