The NHS Alliance's Julie Wood explains how CCGs should avoid ‘Hobson’s choice’ when securing commissioning support

You have an investment in a local private provider, which you made because of your high regard for the quality of care it delivers. You want to continue to referring your patients to the provider, but are concerned new GPC guidance might make it more difficult to do so. Dr Michael Dixon advises GPs on what to do.

As part of moves for your CCG to take on a real prescribing budget, the PCT has set an incentive scheme modelling on the quality premium, including money for quality improvements, but which is only...

Your clinical senate has set out a strategy for your clinical commissioning group that seems focused on high-quality specialist care, but at the expense of allowing any investment to be redirected to the community. You are unhappy about this direction – is there anything you can do? Dr Stewart Findlay tackles this dilemma.

Your health and wellbeing board challenges a decision you have taken to close a hospital dermatology department after a row blows up in the media. You firmly support the decision, but are unwilling to see yourself become a media scapegoat. What should you do?

Half the board members at your CCG have financial links with local private providers, although none at director level. You don’t doubt your colleagues’ integrity, but are concerned about the message it could send out. Dr Tony Grewal explains the practicalities of dealing with a conflict of interest.

Half of the board members at your clinical commissioning group have some financial links with local private providers, although none are at director level. You have no reason to mistrust your colleagues’ integrity, but are concerned about the message it could send out. What should you do? Dr Tony Grewal advises GPs on the best course of action.

You have been elected to serve on your LMC, but are also keen to get involved with your clinical commissioning group, and have been invited to stand for election to its board. Would it be appropriate for you to do so?

Your consortium has plans to shift work from hospital to the community, but you are not convinced the clinical governance is in place to do this safely. Dr Trish Edney advises

Your local Primary Care Organistion is insisting on savings you believe are inappropriate under the new quality and productivity indicators, including end use of several branded medicines you think are important. Dr Trish Edney advises GPs on what to do.

Your practice and all those around you have been signed up as part of a pathfinder without your knowledge. You’re convinced there has not been proper consultation about its structure and which practices should be included? Dr Brian Balmer advises GPs on what action to take.

You have a special interest in dermatology and your partners are keen for you to provide a service for the commissioning group, seeing it as a way of maintaining income. This will seriously impact on your time available for your routine patient care – and your colleagues are not keen on taking on any extra manpower. Dr Michael Dixon advises GPs on how to resolve this.

Your practice is anxious about making commissioning decisions with practices they have previously been in competition with, one of which you suspect of trying to poach your patients in the past. How can you reconcile any potential conflicts of interest? Anne Crofts explores this dilemma.

Your consortium has agreed a LES which contains a component for paying for making your referrals more cost-effective, but you are concerned that this is code for reducing your number of referrals. Should you agree to it? Dr Helena McKeown advises.