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At the heart of general practice since 1960

Why oh why didn't I take the BLUE pill?

Practical Commissioning editor, Sue McNulty, keeps using the word 'matrix' a lot at the moment.

Practical Commissioning editor, Sue McNulty, keeps using the word 'matrix' a lot at the moment.

I keep using the word ‘matrix' a lot at the moment.

I've just looked the word up to make sure I'm using it for the right reason and think I am.

If you google ‘matrix' two things come up – the mathematical rectangle of numbers and the science fiction film starring Keanu Reeves.

I don't have maths A level and have not seen The Matrix - I used the power of google again to find this blog headline - but I still think I'm using the right word for what I mean.

Form and structure seem to be dominating conosortia chat at the moment.

If you're currently an efficient small cluster banking a load of freed up resources (banking in the Weakest Link sense of the word) you might be a bit scared by the recent GPC guidance saying to manage risk you need a consortia size of 500,000.

And if you're a consortium powerful or big enough to be kicking ass with your acute trust you might be worried that if you take on lots of practices who don't really want to be in a consortium then your hard work is about to be unpicked by these practices which are stuck in the status quo of happily referring everyone to hospital.

So, that's what seems to be on everyone's minds.

But what seems to be emerging is that there is a more sophisticated way – the matrix model as I call it – where consortia do some functions unilaterally (eg commission services to meet the needs of patients in the homeless hostel on their patch) while they pool risk with other consortia and then their chair, along with the chairs of three or four other consortia, negotiate terms with the local acute trust. Different things happen at different levels but it all joins up and covers the whole patient population – registered and non-registered.

Actually I think the RCGP might have done a paper advocating the matrix model a couple of years ago, so apologies if I'm using their word.

Anyway, PBC tsar James Kingsland is becoming somewhat frustrated with this preoccupation about the size and form that consortia will have.

And at this juncture I'll just drop in an unfortunate line in the latest letter from NHS chief executive, Sir David Nicholson to PCTs: ‘The significant reduction in management costs, linked to the major proposed changes in commissioning responsibilities set out in the white paper, will require careful and proactive management.' Oh dear. PCTs are hardy enthused at the mo. (Read the excellent Through the K-hole and steve nowottny blogs on to gauge the mood)

Back to consortia. We've just done a vox-pop style piece of 12 consortia and the impression you get is that they think there's a lot more detail to come that's going to illuminate everything. Sorry to disappoint but I've heard the health bill in November and subsequent guidance is going to be pretty light. It's up to consortia to map out their future – if they don't a private firm will.

Interestingly the NHS Alliance and RCGP organised a listening event in Wetherby this week and one of the arguments by GPs was that the Government needs to be even more radical – yes more radical – in terms of changing commissioning rules.

Is there an awakening happening about how much money and power acute trusts have got and how the NHS can be changed for the better? Are GPs looking to the future? Are people walking around at commissioning listening events wearing long dark coats and black glasses?

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