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Questions, questions

Practical Commissioning's blogger has been swapping Andrew Lansley anecdotes and discussing the coalition health policy with colleagues

Just had an interesting session with my SHA colleagues and a group of PEC chairs, GP commissioners and whatever else we call ourselves as clinical managers and leaders. John Haworth, Cockermouth local hero of the floods and ICO national pilot lead, was leading a presentation about what we're doing in Cumbria. At least he's got a success story to tell with huge improvements in productivity at his community hospital with shortened length of stay, reduced staff costs and increased throughput. Consequently he's spending less on acute admissions and much less on the dreaded non-elective excess bed days. What was going to be my contribution, asked one of my colleagues, well aware that the year end for my locality had brought a £2.5M deficit which would have threatened the county's financial balance if it hadn't been offset by John and colleagues' admirable savings? When I explained that I would be saying my piece, too, the unkind response was that not only did the emperor have new clothes but they were beautifully cut!

The pervading atmosphere at the SHA was one of rune-casting, fortune-telling and crystal-ball gazing; instead of inspecting the goat's entrails we were consulting Blueberries and ePads and swapping Andrew Lansley anecdotes. Everyone had met him and everyone was predicting a different future. ‘QIPP is the only health acronym retained by the coalition government,' was countered by a terse ‘He hates QIPP'. ‘The budgets are going down to individual practices', balanced by ‘No, only consortiums will manage budgets.'

The same old worries surfaced round the group – how do you get the rank-and-file docs to engage with management tasks? How are we going to manage a practice that doesn't want to play ball? ‘We will expel it from its consortium'. What does that mean for the practice in practical consequences? Are we going to pay them less? Not let them refer? What are we going to do with a consortium that fails? What size, in terms of patient populations is safe financially? ‘About 100k but you can have smaller consortia, say 30k population if they risk share with others.' The reality is that these questions about how you run a very small health economy will need to answered on the shop floor not the ivory tower.