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The PBC diaries: Mob Rules

In the latest instalment of the PBC diaries, our protagonist learns that doctors are a useful ally for PCTs when it comes to selling unpopular healthcare plans to a dissenting public

In the latest instalment of the PBC diaries, our protagonist learns that doctors are a useful ally for PCTs when it comes to selling unpopular healthcare plans to a dissenting public

The story so far

Dr Peter Weaving is a GP in north Cumbria and former chair of a large PBC consortium. He is now a locality lead for Cumbria PCT, sandwiched between clinicians and managers as they attempt to implement practice-based commissioning and related service reforms. His latest task is trying to persuade the public that replacing hospital services with community provision will be a good thing.

‘Save our hospitals!' ‘Save our maternity unit!' The cries of the people echo in our ears as we enter into the final throes of a 14-week consultation process. The PCT's radical plan on the future of healthcare provision in Cumbria – ‘Closer to Home' – is being subject to trial by fire at the public meeting.

We are holding five meetings around the county and the temperature rises rapidly as you travel west, where the changes will be felt most keenly. There, the district general hospital will be much smaller; specialised services will move east; and, although community services will expand, if you live in the west it looks like cut after cut.

As clinical lead for the Carlisle patch (in the east), it was my job to sit on the panel at our area's meeting and answer questions on the future of the community hospital. The only warmth over the plans, let alone heat, came from a hardened Unison rep from Whitehaven in the west. She had come over for a warm-up prior to the main event on her home turf in a couple of days' time.

The PCT, too, had made preparations for the meeting in the west, after a bruising initial round the year before. The highlight then was the booing of controversial comments made by the director of public health, who told the the audience they should appreciate the calibre of the new management. His coup de grace was advice they should ‘go forth and procreate' if they wanted to retain local maternity services.

This year we were ready. Beefy, tattooed bouncers unchained the doors and let the crowds in – the lucky first few hundred taking the seats, the rest lining every wall and covering every square foot of worn parquet floor. Facing the public was the PCT's panel, which included handpicked members from senior healthcare ranks with both GPs and consultants represented.

The PCT's chief exec and the local authority's social services head were pictures of quiet professionalism. Our director of market development had become the PCT's ‘senior nurse', and the director of public health was gardening. Last minute horse-trading on bed numbers with the church and local consultants had repositioned previous strident dissenters.

After a dire presentation (PowerPoint, no pictures), punctuated by general muttering and the occasional shout of ‘rubbish!', we moved on to questions from the floor.

It was then that the wisdom of getting the docs not only on board, but in the firing line, became apparent. The audience's grumbling negativity turned into ‘ooh, that's my doctor'.

When the medics were put on the spot but still supported the plans, their views carried weight and credibility. As far as the public were concerned, the managers were clearly there just to save money. But doctors – now they do what's best for you.

It would be stretching the truth to say that the crowds were converts to our cause but it looks like we're through to the next round…

PBC diaries

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