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Sleeping with the enemy

In the unchartered territory of PBC, one doctor valiantly battles for the greater good. Join him in the first instalment of the PBC diaries...

In the unchartered territory of PBC, one doctor valiantly battles for the greater good. Join him in the first instalment of the PBC diaries...

The story so far

Our protagonist Dr Peter Weaving, a full-time GP in North Cumbria, chairs the not-for-profit consortium, CueDoc PBC Ltd, comprising 38 practices serving 228,000 patients. As CueDoc heads towards the end of its first operational year, it faces many challenges, not least that its PCT (Cumbria) is believed to hold the biggest overspend in England (£38.5m this year, predicted to rise to £100m by 2010).

We join Dr Weaving as he is interrogated by Department of Health officials on the area's commissioning capabilities.

‘Collaboration?' she breathed at me. ‘What do you mean, collaboration?'

I was in the bowels of the crumbling bastion that is our new PCT's headquarters, being interviewed by the Department of Health's fitness-for-purpose team interrogating PCT capability.

The other interviewer leaned forward. ‘Who's been collaborating, Peter? You can tell us – we're your friends.'

‘We thought,' I swallowed. ‘Well, she [our PCT chief exec] thought, er, said that if the GPs got together with the hospitals and the consultants, and worked with each other, we could make things right, you know – for the patients.'

‘But, Peter,' she said, ‘where does that leave patient choice and value for money? How will you show contestability for services? How will you engage with the independent sector?'

Any moment now, she's going to hold up four fingers and ask if I can see an Orwellian fifth, I sweated.

‘Just think about it,' the interrogator concluded. ‘You can go now, Peter. We know where you live if we need you.'

I burst out of the building and cursed. This was all wrong – our consortium's plans to transfer services from secondary to primary care were bang in line with Government thinking. Yet here I was defending a policy that would have been beautiful anywhere outside a market forces health economy.

I drove slowly towards an afternoon surgery that would include playing ‘She-loves-me, she-loves-me-not' with Choose and Book. On the way, I phoned the chief exec of our PBC consortium to hear the latest lowdown.

‘The ENT consultants are marching on the streets about the CATS centre,' he said. ‘The acute trust said if we so much as cauterise a nose in the community the west DGH will slide into the Irish Sea – it will be your fault, and that's what they'll tell the press.'

He went on: ‘You can't get a routine cardiology appointment at the east DGH nor a dermatology one in the west – yet we can't get approval to set up GPSI services to help out. The only target we're on course to hit is that of the health economy with the biggest deficit in the land.' Business as usual, I sighed.

But now, after years of a monopoly acute trust run by a strong leader – let's call her The Iron Lady – a saviour had appeared in the form of our new PCT chief exec, a tough, well-connected and charismatic woman.

We waited for the mother of all scraps between the two, to see whether PBC could skewer the trust's Payment by Results shield.

But in vain we waited. The two embraced on the field, made light of their differences and signed a peace treaty promising care streams, joint working, managed health economies and co-operation.

Will peace prevail and quell the market forces? Can we make PBC work without conflict? You'll have to wait and see in the next instalment.

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