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Yes, (shadow) minister

This month, our diarist gets to meet the shadow health secretary and find out what the new post-election world might look like

This month, our diarist gets to meet the shadow health secretary and find out what the new post-election world might look like.

The story so far

Dr Peter Weaving is a GP in Cumbria and a locality lead for Cumbria PCT – a role that can be challenging as the PCT looks ahead to financially leaner times and tries to get two integrated care pilots launched...

‘Practice-based commissioning is clearly not working,' says the Rt Hon Andrew Lansley MP, CBE. ‘And the reason it is not working is a failure to engage GPs.'

The shadow Secretary of State for Health is an imposing figure; tall, grey, firm grip, sustained eye-contact, a Kennedy elder. He has kindly agreed to meet a posse of us from the PCT and has politely listened to briefs from my management and GP colleagues on securing clinical engagement; bridging the gap between the activity of an acute trust and the needs and desires of Joe Public; the modernisation of a small community hospital and where we are going with our integrated care organisations (ICOs).

And now we want to hear his views.

‘GPs are not engaged because they do not have real budgets for their patients,' he continues. ‘We will ensure they have total budgetary responsibility – not full budgets to practices from the outset – we want effective pragmatic change not acute reform. Practices will align themselves to reduce risk, lower overheads and take forward the lessons from fundholding. Their support may not come from their PCT but from the independent sector.'

Mr Lansley knows GPs; our QOF, and our Dee Eee eSses, as he calls them. ‘We know some practices will not want to take an active part in the commissioning role of these consortia; that their colleagues will do it on their behalf. We want local decision-making, and believe an inner-city solution may not apply to a rural community; for example extended hours rules may need to be applied differently to achieve benefits for patients in different areas. Do not expect a national framework solution for every problem. Do expect to be inextricably linked to the public in your decision-making. We expect the public to access data on health outcomes to inform their treatment choices.'

At this point Mr Lansley has to bid us farewell and take his place for the press photoshoot, which I am delighted to see is taking place in the primary care assessment service at the hospital's front door.

This is all very encouraging; our direction of travel in terms of federated groups of practices working within a collaborative to produce the most cost-effective, good-quality outcomes for a defined population is the right one. It looks as though ICOs are with us in this world and the next.

The dilemma we are left with in primary care is that both main parties want GPs to step up their gatekeeping role – reducing, or at least containing, costs in a worsening financial climate. Frontline GPs are best placed to do this – we spend NHS money by prescribing, referring and admitting. The reality is that PBC or fundholding or total purchasing only engages a minority of us.

How do we persuade clinicians to rally behind the very unsexy banner of health economics? The GP sitting in his consulting room with a patient is that person's advocate to secure the best treatment for them; the impact of those actions on the health economy that supports the other 499,999 patients in Cumbria is secondary and will always remain so. Now is that a problem for the politicians or for us?

Our diarist gets to meet shadow health secretary Our diarist gets to meet shadow health secretary

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