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No one mentions cox-2 efficacy

Tempting though it is to view practice-based commissioning as the latest in a long line of isolated initiatives, there is clear link between the policy (such as it is, currently) and the established directions set by the Department of Health through payment by results, foundation trusts, patient choice and the new GP contract.

Recent measures on specialist PMS and the guidance on APMS show that practices will no longer hold the monopoly on community services.

But PBC offers a framework by which clinicians and managers could come together to create the contractual relationships to deliver services that practices and patients want.

By placing power and responsibility in the hands of the GP community, PBC offers a realistic prospect that the right people have the opportunity and the incentive to improve care and increase efficiency.

Fighting this good fight from the trenches will require real fortitude from the troops, however. The managerial responsibility and commercial duties of PBC will require a major strategic shift in the hearts and minds of already fatigued GPs.

My clinical colleagues rightly view new work coming their way as unwelcome, new non-clinical work doubly so, and treat with suspicion any initiative coming from a department which has no record of sympathy with our own aims and objectives.

Nevertheless, the fact is that practices have been commercialised whether they like it or not. Perhaps getting on with it and finding the managerial capability to support the effort is the right thing to consider, for

surely the prize is sufficiently great to warrant the action.

Dr Richard More

GP and Primary Care

Management Consultant



·There is little merit and questionable value to readers in publishing unbalanced articles, or when a reporter or editor demonstrates a premeditated bias.

Such is the case with the article headlined 'New rules make practice-based commissioning 'unworkable'' '(News, January 15). Pulse clearly chose to exclude the positive and constructive comments concerning practice-based commissioning from the true 'supporters of the scheme'.

Completely excluding information from interviews when there is a difference of opinion to that planned to be published only misleads your readers and potentially discourages organisations from giving interviews in future.

I have spoken at numerous meetings run by strategic health authorities and PCTs. I find there is considerable enthusiasm for practice-based commissioning and a significant number of practices are ready and willing to start on April 1, 2005.

Dr James Kingsland

Chair, National Association for Primary Care

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