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Commission impossible?

There are a few issues I would like to share about commissioning from the perspective of a small practice:

•The Government should not force practices that are not like minded to join a consortium. If new consortia are formed, they are unlikely to be representative of small practices.

•The success of PBC has been variable. We have heard this will be different, because of the new bottom-up approach. But making commissioning compulsory is surely a top-down approach.

•The legacy of Tony Blair's regime still exists in the differential treatment of small practices. They are undervalued, given unnecessary inspections and forced to work under performance frameworks. Meanwhile, millions are still spent on duplication of services, such as Darzi centres.

•Commissioning will fundamentally change the GP's relationship with patients, and take GPs from exercising their clinical skills to reducing referrals and saving money.

From Dr Krishna Chaturvedi
Southend-on-Sea, Essex

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