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At the heart of general practice since 1960

A bit more grit required

Dr Michael Dixon, NHS Alliance chair, appeals to GPs to avoid the ‘dark forces’ of inertia and centralism and push PBC forward

Dr Michael Dixon, NHS Alliance chair, appeals to GPs to avoid the ‘dark forces' of inertia and centralism and push PBC forward

Practice-based commissioning offers general practice a leadership role as never before. It is our licence to lead decisions on all local services and hands us an extended role in providing those services. In an uncertain world, it is the promise of a certain future.

It also represents a rebalancing of our role from being absolute advocate of each individual patient to also being an advocate for all other patients on our practice list. It makes us responsible for the best good, for the greatest number. According to a MORI poll carried out in January, the public feel that clinicians and patient groups are the most credible in terms of making these difficult balancing decisions. We shirk PBC at our peril!

But PBC has had a slow start and we must all shoulder the blame.

Central reorganisation of primary care trusts has meant a period of uncertainty and change, which has lost us six months or more.

The overbearing emphasis on financial balance and 18-week waits has also paralysed PBC in some places, although PBC can be the answer to these things.

Too many PCTs have insufficient manpower, experience or authority in their commissioning teams. This means they have been unable to provide budgets, information or satisfactory help for practices to do the job. A few PCTs seem reluctant to hand commissioning ‘power' to clinicians on the front line, but fail to see that without their clinicians they have no commissioning power anyway.

‘My worst fear is that general practice drags its feet and gets hauled into PBC reluctantly'

As GPs, many of us have not done so well either. Dragging our feet – as we have so often (from the establishment of the NHS in 1948 onwards) – we have failed to see that PBC is a chance to up our game. Why? Some have felt that the short-term financial gains were too small but failed to read the future. Others feel that it is a Government plot to control us but fail to see that the new GP contract has done that far more than PBC ever can. Others are worn down by red tape and bureaucracy in a system that too often fails to respond to its frontline clinicians.

Nice intentions, no action

Without concerted action by all of us, PBC is on course to become a tragedy in the best classical sense. Nice intentions, no action. Symptomatic of this is the claim by strategic health authorities that almost 100 per cent of practices are now engaged in PBC. Meanwhile, whenever I ask audiences of GPs and practices how many are currently involved, only a fraction put up their hands. We have all got to get real.

That means PCTs and practices really talking to each other and realising that neither has a future without the other.

It also means general practice exerting its can-do philosophy. If we are determined, courageous and proactive then the future holds no fear – because we will be empowering ourselves to determine, design, implement and be part of that future.

My worst nightmare is that general practice drags its feet, gets hauled reluctantly into PBC and that it becomes simply a means of demand managing referrals, diagnostics and prescribing. That would be playing into the hands of the dark forces of inertia and centralism. My best dream is that general practice grabs this new role to lead and commission, from the hand that offers it, and thus becomes the big benign beast of NHS success.

Dr Michael Dixon is a GP in Cullompton, Devon, and chair of NHS Alliance

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