Bill leaves GPs no choice but to use private support

Just one correction, but an important one.

The real decisions about what to buy from whom, and what general practices will have to do, will no longer be taken by NHS management, but instead by a small number of Commissioning GPs. Yes GPs, not privatised CSOs.

CSOs are just that - support. It doesn't matter if they are privatised or just hosted by the NCB. Prioritisation and decision making is for CCG GP leaders. They will also need to contract with and direct the CSOs so that the CCG gets the information, intelligence and support it needs.

GPs need to step up to the plate and lead so that they can get their CCGs authorised. If GP leaders don't lead then your CCG will not be authorised and your local services will be commissioned not by the CSOs but by the NCB. The CSOs will instead help the NCB rather than your CCG.

Now is the time to lead and step forward and accept accountability for making decisions. If you don't others will fill the seat with your name on it.

The support for commissioning is not, I think, voluntary. The impression I get is that 'support' is de rigeur and CCGs will be forced down a particular route - remember FES support for World Class Commissioning. And as for support from McKinsey et al, our experience is that of having our brains picked and then much of the same material being reproduced on powerpoint slides copyrighted to the company, and paid for by the NHS. We should be told in advance what this support is going to cost the NHS - and whether it will be over and above the usual management costs.

And is response to Graham, yes GPs will be responsible, but given that their principle focus will remain their practice, how will they be able to make the decisions against any offered 'advice'. And we have seen nothing yet about the accountability framework to the public GP commissioners. At least a PCT had a board - and it met public.

CCGs will commission and contact for commissioning support from CSOs. The 6 domains of commisisoning support 'advice' will not provide CCGs with any answers, merely supporting evidence from which the CCG leaders will be required to make decisions and prioritise investment.

If CCGs can't make decisions then what additional value are they adding for their £25 per head? They will be de-authorised and the NCB will make their decisions for them instead.