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Pathfinder lift off

A visit to Number 10 finds our diarist realising his own enthusiasm for the reforms – and the scale of the opposition out there.

The story so far

Dr Peter Weaving is a GP and locality lead in Cumbria, now deemed a cutting-edge pathfinder consortium in light of its commissioning successes – not least in steering the PCT out of a £50m deficit. But while it might be working now, our diarist is under no illusions about how radical the reforms are and what difficult challenges lie ahead…

It's official: pathfinders are go. We've had a launch event in London with health secretary Andrew Lansley, Dame Barbara Hakin and Sir David Nicholson waving us off. Or was Barbara bon voyage and David feeling our collar?

Mr Lansley kindly took questions, the first of which from an alleged pioneering GP commissioner went like this: ‘I would just like to say I don't agree with any of this. It's yet another unnecessary, unwanted, top-down reorganisation. I'm only here to keep an eye on you and make sure you don't mess up my NHS.'

Completely unfazed at finding a hunt saboteur drinking from his stirrup cup, our honourable friend reminded the questioner that it was bottom up; she was in charge and could make what decisions she chose – apart from the obvious one of wanting to have no part in GP commissioning.

I myself am an unashamed enthusiast for the reforms insofar as clinicians need to take ownership of the financial implications of their clinical decisions. And not to sound too trite, these decisions are best made in consultation with secondary care colleagues supported by the relevant management expertise and an informed and empowered public. I accept, though, that coming from the woolly Cumbrian fells, finding any provider, let alone a willing one, makes

us naïve about competition and the metropolitan consequences thereof.

Later in the day, a selected group (all of us) was invited to Number 10 to meet the PM and other interesting people. I met an imposing tall version of Steven Berkoff – who turned out to be Tony Delamothe, deputy BMJ editor – who was also less than enthusiastic about GP commissioning. ‘Read my editorial,' he growled. The cover of the next day's BMJ featured the title ‘Dr Lansley's Monster' superimposed on Frankenstein… The Prime Minister appeared and Tony moved off to fix him with a hard stare.

Now the PM is a fan of GP commissioning and explained why – we had regular contact with patients, we knew what was good locally in terms of services and we knew what should be improved. We made the decisions about where patients went and it was right and proper that we had the financial ability, and responsibility, to steer and develop those options appropriately. He also observed that we may meet his children careering through and could we kindly check them for nits; he canvassed opinion about their best management and declined the shouted offer to ‘Shave their heads!'.

He went on to explain that he could not offer an alcoholic beverage at this reception and expressed his disappointment at being unable to make an exception for doctors, whom he knew would be responsible, but it was against the rules of his house.

I smiled at the thought of these responsible clinicians with a free bar and turned to find myself face to face with our very own editor, Sue McNulty. She'd squeezed in an interview with Dame B but then had to cut the PM for a PTA meeting. It's good to prioritise.

Later, somewhat intoxicated with the day, rattling my way back to Cumbria, I was faced with a Virgin train manager out of Euston. ‘Now, sir, can you explain why you are not travelling on the only train for which this ticket is valid?'

‘Er… I met the Secretary of State for Health and he invited me to Downing Street to meet the Prime Minister?'

He fixed me with a Paddington Bear glare for a full 20 seconds then wrote ‘travelling late for personal reasons' on the back of my ticket, stuffed it into my breast pocket and moved on down the train.