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At the heart of general practice since 1960

The next generation

Our diarist finds himself teaching commissioning to budding consultants this month and facing some searching questions

The story so far

Dr Peter Weaving is vice chair of Cumbria CCG, one of 35 in the country going for first-wave authorisation status this autumn – a move that will make the CCG responsible for a cool half a billion pounds of healthcare throughout Cumbria.

A self-proclaimed commissioning enthusiast, just like everyone else he is still getting his head round what the health act will mean, how it is best implemented and whether all players involved are actually necessary. His ‘training’ will stand him in good stead for the challenge ahead, surely…

As I drive over the River Wear, the greatest Norman building in England, Durham Cathedral, looms over me lit by early morning sunshine. For a morning, I am leaving the melee of authorisation, contracts, commissioning and service development and entering the quiet academic atmosphere of the colleges of Durham University. Yet I feel butterflies in my stomach as before any confrontational meeting with a bullish provider or intransigent foundation trust.

My anxiety stems from the audience I am about to face. I am the country GP in a tweed jacket with bailer twine in the pocket and straw behind my ear and ‘they’ are the next generation of neurosurgeons, orthopods and geriatricians. These senior clinicians – already so sub-specialised there is even a paediatric cardiac intensive care-ist – are undertaking a course in management as the final polish to consultant training. Part of that is about working with primary care and understanding, or trying to, what stage of healthcare reform we have reached and what it will look like and mean for their future consultant careers.

We begin. I explain the arrangements we independent contractors work under and how primary care, too, has changed from a front-room cottage industry to proactive, industrial-scale, long-term condition management. We discuss the pros and cons of the gatekeeper function balanced by being the patient’s advocate. No problem.

We move on to the dissolution of SHAs and PCTs and their replacement with CCGs, health and wellbeing boards, clinical senates and the whole lot under the NHS Commissioning Board run by Sir David Nicholson (of whom not one had heard).

We did not even touch on commissioning support. Polite perplexion best describes their reaction, but I’m getting better because usually at least two would be asleep by now.

Tariff, productivity and coding proved familiar territory and clearly the fortress foundation trusts that most of my ‘students’ worked in had well-established induction programmes for new troops. We explored how they would go about implementing a service change – either starting something new such as the latest Duypetren’s treatment or changing an existing service, and what to do first in their own trust in terms of business planning before taking it to me as the commissioner. The super-specialised in the audience were reassured their own services would be commissioned direct from the centre by experts, while the majority of their colleagues’ endeavours would come to me. And they looked even more consoled when my own qualifications, training and appointment as a commissioner were explored.

‘You were elected?’ they repeated politely.

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