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The end already?

In the second instalment of the PBC diaries, our protagonist reveals a development that left GPs feeling their honour had been impugned

In the second instalment of the PBC diaries, our protagonist reveals a development that left GPs feeling their honour had been impugned

The story so far

Dr Peter Weaving, a full-time GP in north Cumbria, has spent the last year chairing a not-for-profit consortium, CueDoc PBC Ltd, comprising 38 practices serving 228,000 patients. His PCT is struggling with the biggest deficit in England, and the chief exec drafted in to sort it out is about to take drastic action…

‘Practices are closest to patients – they will have the opportunity to shape services and clinical pathways!' This battlecry should have heralded opportunities for our PBC consortium to commission and develop the services its constituent GPs and patients wanted. But our area is not following the national path of a feisty market economy with weak hospitals and uneconomic services going to the wall and the gaps filled by a mix of entrepreneurial primary care professionals, the independent sector and more predatory secondary care providers.

No, we are to become, effectively, a managed health network. The soaring debt we have inherited, in no little part a consequence of trying to run four district general hospitals covering a huge area, whose capitation funding only supports one, is to be reversed by a massive programme of investment and reorganisation in community and community hospital services. But the presence of our large PBC consortium, with strong links to a parent private organisation keen to provide healthcare and related services, was seen as an unacceptable fly in the ointment.

This is despite the strenuous lengths we took to split the commissioner and provider functions, setting up the PBC consortium as a separate, limited, not-for-profit company with its own board and executive.

The PCT claimed it had no problem with our structure; rather it was the perception of its partners such as the acute trust, social services and other investors. We were accused of being too big, too destabilising and of crossing more than one of the locality authority boundaries. Quite bluntly, the PCT told us we were not an acceptable partner in its brave new world.

Our GP members felt their honour was being impugned and, following a few stormy meetings with the PCT, the consortium's executive felt it had no choice but to pull the plug.

Supportive colleagues in primary care made ripples about our case that reached the health secretary. But national rules do not apply to a health economy with a deficit on our scale; the newly appointed PCT chief executive has support from above to do as she sees best to fix the local health economy. The consortium is an early casualty, and with it our various proposals for redesigning care.

My year as chair of the consortium was painful – nine months banging my head against the door of the reconfiguring PCT to be let into the commissioning room; followed by three months banging my head on the table to be let into the discussion.

So where does that leave us? Bizarrely, I think we are going to end up where we were. Our consortium's members, who fought for what was reasonably their right to organise themselves as national guidance suggested, are now being asked to gather into smaller localities.

This won't dismantle the original clinical relationships that have developed across the patch – we may have been surgically excised from our founding consortium but like any good graft we will grow again.

Who knows, by the next instalment, we might have become practice-based commissioners again…

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