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My highlighter has been busy

So it's out. The White Paper has foretold a seismic shift of power to GPs by giving consortiums real budgets.

I've just been through it with my highlighted pen and thought I'd share with you the most interesting bits and my top questions I feel this leaves:

- Patient-Reported Outcome Measures to be extended across the NHS wherever practicable

- Patients to have choice of named consultant-led team for elective care by April 2011

- A new NHS outcomes framework to contain a set of goals determined by the Secretary of State that commissioners need to work to

- NICE to create some 150 standards of care that will set out what should happen at each step of a patient pathway

- Further incentives to reduce avoidable readmissions to be implemented in 2011/12

- NHS Commissioning Board to set budgets for practices and these to be allocated to consortiums rather than individual practices

- Consortiums to include an accountable officer

- Every GP practice must become part of a consortium and the NHS Commissioning board will be able to assign practices to consortiums if necessary

- GP consortiums to decide what aspects of commissioning they will do themselves and what to buy in from external bodies including local authorities, private and voluntary sectors

- Risk pooling required by GP consortiums

- ‘The Government will not bail out commissioners who fail. Regulations will specify a failure regime for commissioners'

So my burning questions after getting head round that lot are:

- Who is going to head up this Commissioning Board and how will they be appointed/elected?

- How is the board going to set budgets that allow GPs to get off the starting blocks with a decent chance of staying within budget? Start off with a incorrect budget for your population and your commissioning is doomed for failure

- How can savings be spent? Do they have to be reinvested in the NHS or can they go towards practice profits?

- Are we still going to have World Class Commissioning?

- Is it realistic to expect all GP consortiums to stay in budget when it's hardly the case that PCTs managed this?

- What about providing services if you're a GP commissioner? Assume this is still OK but not exactly spelt out in white paper.

- Isn't it going to cost an arm and a leg in redundancy payments to abolish PCTs? How big is that figure and won't it swallow up all the savings made by the bold white paper?

Editor, Sue McNulty