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Andy Jones: No time like the present

This is certainly a time of opportunity and change for general practice.

This is certainly a time of opportunity and change for general practice.

We have got rid of our out-of-hours commitment. We have got to grips with performance-related targets. Our pension dynamising factor has been boosted in a most satisfactory way. And there remains one huge mouth-watering prospect for us in 2006. Practice-based commissioning.

I have suggested in this column before that practice-based commissioning will result in a lot of conflicts for a great many people in the NHS, and that health care is about to become a business with conflicting interests at stake. For example, GPs will have to make decisions that in effect ration the health care of their patients. PEC chairs will be taking up appointments as clinical directors of private companies (I have heard that this is happening already). Senior NHS personnel are being awarded advisory contracts and honorariums from private providers.

But practice-based commissioning will result in a lot of opportunity too. Traditionally little work has been transferred from secondary into primary care because general practice is said to be too fragmented to take on tasks traditionally done in hospitals, such as diagnostics, outpatient care and minor procedures.

Strength in numbers

But if strong and well organised practices work together anything becomes possible. And this is what could happen. Clinical engagement has been set as a priority and GPs are being encouraged to team up as private companies or mutual trusts to take on practice-based commissioning. It is all very challenging.

From what I hear there will be an open goal to commission and provide services at the same time. There are no guidelines on contestability, clinical governance or conflicts of interest. This will enable enlightened GP's to take control of localised health markets and suddenly gain the ears of PCT and hospital managers, work fully with consultants for the first time in ages and have a say in private competition from outside interests.

Will this give too much power to GPs? Many commentators suggest it will. But giving a lot of power to the PCT has not exactly worked wonders, has it?There are many threats and opportunities facing the NHS as the reform begins to surface. But do read the guidance on practice-based commissioning. The White Paper will probably be seen as a threat. But I would class practice-based commissioning as a huge opportunity.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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