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So are GP commissioners really 3 out of 10 at best?

By Richard Hoey

The NHS's chief executive is scathing about GPs' abilities to commission. But the managers' manager must know his own lot haven't done so well either, says Pulse editor By Richard Hoey

Sir David Nicholson, chief executive of the NHS, reportedly earns a tidy £252,000. But it doesn't sound like that's enough to persuade him he wants to stick it out at his job.

Not from the evidence of his speech at the NHS Confederation's annual conference, anyway, where he used his biggest platform of the year to enthusiastically ridicule health secretary Andrew Lansley's GP commissioning plans.

According to Sir David, GPs are nowhere near ready to take on 95% or more of PCTs' commissioning roles (or around 80% of the entire NHS budget). In fact, he reckoned, even the very best GP commissioning groups, scored out of 10, would only get ‘about a three'.

It's safe to imagine that Sir David's comments won't have secured him that peerage just yet. But while they presumably won't go down well with Andrew Lansley, they may find more sympathy in other parts of Government, judging from the reported Treasury concerns over the GP commissioning plans.

And before we rush to outrage, he does have some semblance of a point. Expecting GPs to take on huge swathes of PCT commissioning just like that is hugely ambitious, and will scare the profession witless if it's not done right.

It will only work if there is proper managerial and back-office support, and proper incentives too. Most GPs are heading for six pay freezes in seven years, and if they're going to throw time and energy into commissioning, they need to know they'll get more for it than a pat on the back.

Where Sir David got it badly wrong is in what he chose to omit. Because, and I put this mildly, it is hardly as though PCTs have covered themselves in glory with their commissioning in recent years, is it?

Certainly not from the evidence of out-of-hours services, which in some areas of the country have teetered at the edge of shambles since GPs opted out of responsibility for provision, back in 2004.

It is going to be a very steep learning curve for GPs to take over as the NHS's preferred commissioners. But that doesn't mean GPs won't make a decent stab at it, and certainly doesn't mean they can't do a better job than what has come before.

By Richard Hoey, Pulse editor