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Gold, incentives and meh

Just commission, will yer!

Susan McNulty finds a legendary reality show catchphrase pops into her mind while at the NAPC's annual conference.

Susan McNulty finds a legendary reality show catchphrase pops into her mind while at the NAPC's annual conference.

The Adelphi Hotel, Liverpool. Setting for the 10th NAPC annual conference 2008.

An amazing Edwardian building where you can't stop yourself looking up at the gold leaf, the chandeliers, the original clocks.

Originally built to accommodate the passengers of the White Star luxury shipping fleet including those who sailed the next day on the Titanic.

But the Adelphi also has another – albeit lighter - place in history: creating one of the most well know reality TV catchphrases ever ‘Just cook, will yer!'.

In the 1990s a film crew was allowed behind the scenes and the main subject became the embarrassing management with this catchphrase emanating from the deputy manager to the moaning chef.

Anyway, the highlight of the conference was shadow health secretary Andrew Lansley's speech.

What would happen to PBC if the Conservatives got in?

No-one seemed too reassured by what he had to say.

Mr Lansley began by saying there should never be a return to fundholding because of the ‘two-tierism' this created in the NHS and its inability, as was the case now with PBC he said, to deal with the conflict of interest.

Tactlessly, he spoke of pouring cold water on integrated care organisations saying you didn't need organisations to deliver integrated care.

Wonder if he knew there were at least two prominent ICO bidding groups in the audience who have doubtless spent endless hours putting their bids together.

Instead Mr Lansley talked of separating providing from commissioning with the result that commissioners would have their minds focused on patients and ‘not on incremental monetary decisions about what needs to be provided.'

But why the need to separate providing from commissioning?

Primary care tsar, Dr David Colin-Thome clearly doesn't have a problem with PBC groups doing both – ‘As an individual doctor I have been a commissioner for 36 years but I call it referral' he told the first Practical Commissioning/Pulse PBC training workshop. (see October news)

And I never hear other PBC policy makers harping on about it.

Yes of course transparency is needed and the GMC has addressed this in its latest version of Good Medical Practice.

Is it really that awkward to have the following conversation with your patient:

‘You need to be referred. You can go to the hospital and be seen in three weeks time or you can come back here next week and my colleague will see you and hopefully be able to treat you there and then.

‘I must inform you that my colleague, to put it into layman's terms, is employed by a company that I am a shareholder in and we make a profit out of providing this service. This leaflet gives you more information if you want to know more. What would you like me to do?'

More details are needed from the Conservatives about what they intend to do with PBC.

Their proposal for devolved budgets will be welcomed. But if a clampdown on the conflict of interest is the price to pay, many GPs will be unhappy being told ‘just commission, will yer' by their PCT managers.

Susan McNulty, editor of Practical Commissioning

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