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The next five years

After spending time with a number of health service strategists and politicians I would like to give you my thumbnail sketch of the health service of the next few years.

In the health service of the future Mr Lansley is going to give an independent NHS board a cheque for £100Bn. That board will not be staffed by the department of health but may be chaired by someone such as the outgoing chief executive of Tesco.

The board will then divide the money into two streams: £40Bn will go down to practices as their GMS or PMS or new contract income. The remaining £60Bn will go to 400-500 GP consortiums each covering populations of about 100,000 people. This money is to pay for 95% of the secondary care these individuals need which the consortia will commission on their behalf.

Clearly consortiums will need support functions in finance, contracting, IT and performance monitoring which they will buy in from PCTs or whatever they become. There will be a capitated management fee for each patient of around £8 to pay for these commissioning support functions.

The immediate questions are around conflict of interest, role of other independent contractors, employment of community staff, commissioning ability of consortiums, engagement of clinical leaders to name but a few! The answers need to be found but not at the expense of stifling innovation under leaden regulation.

Is this the challenging solution for challenging times?

Dr Peter Weaving is GP and locality lead in Cumbria