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Sometimes it's liberating to be Powerless

Our blogging GP commissioner, Dr Clive Henderson, senses how taking over the reins of power will also mean responsibility and accountability - eek!

Our blogging GP commissioner, Dr Clive Henderson, senses how taking over the reins of power will also mean responsibility and accountability - eek!

When I am out walking my dogs I am reassured that a hare chase poses no threat of carnage. They have tended to be too old, fat or patently unsuited to task.

Much the same logic applies when my wife watches me chat/flirt/embarrass myself with an attractive waitress. No chance. No worry.

Sometimes it's quite liberating to be powerless.

Trouble is now we GPs are to be handed the reins of the NHS, we cannot sit back and blame the PCT.

Or maybe we have a brief window of opportunity to still hide behind them. Let's get all our rationing decisions done now before it's our fault.

That bloody PCT has cut this, that and the other. Damn them that nasty lot.

Regrettably the rationing is also extending to GP contracts. We have just had a Turkeys-voting-Christmas session where we, as chairs, have been asked to put to our locality forums which DES/LES should be lost ‘should it prove necessary'. Extended Hours payments looked the only conceivable one of the options which Hobson would have recognised.

I am starting to worry that grassroots GPs may start to see their elected commissioners as the enemy, as we change from being the messenger to the message-maker.

Commissioners must avoid being perceived as mini despots to their own bigger agenda and need to be seen to engage with , promote and be a fully integrated part of general practice.

Take ‘creep' for instance. That process whereby more and more previously secondary care activities morph into primary care ones. I won't bore you with examples because they are manifold and recognisable. The principle is fine. We GPs ought to be effecting better care, closer to home but the ‘within budget' part of the triptych mission statement banner, must not be achieved by abusing our own colleagues. If we are to save £1000 by new pathway reform involving extra GP work then a profitable percentage of that needs paying back into general practice.

With the emerging power, commissioners need to tread a careful path to responsibly support primary care because it's soon to become all our fault and our colleagues will hold us to account, as well as the public.

Dr Clive Henderson

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