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On the ground


Dr Peter Weaving is a GP and locality lead in Cumbria and something of a commissioning enthusiast. His optimism for what clinical commissioning can achieve is, however, often tempered by local challenges such as overcoming consultants' concerns about the reforms, avoiding a deficit and ensuring GP commissioners engage with patients...

‘Number seven needs to sort her garden and fix that broken window. I've written to the council twice. She works as a cleaner at the hospital so she's on good money.'

I've joined Jane, my director of public health, at a local community association meeting on a deprived estate to listen to health concerns and perhaps explain about clinical commissioning groups (CCGs).

‘Dog muck!' a member of the group exclaims, and opens the floodgates for a tirade of complaints about poos on the pavement. We are down to one warden fighting fouling for the city and nobody will drop a neighbour in it for fear of reprisal. There is a clear public health issue, but for them – and me – the more important concern is instilling a community spirit such that my neighbours believe it is not nice to let their dogs shit outside my house and that the right thing to do is to bag and bin it.

I steer the discussion to the equally delicate subject of local health services and the role we clinical commissioners have in securing the best services we can within a finite financial envelope. To my amazement, this appears to meet with approbation and warm approval. Before I can settle back in this friendly atmosphere, we have to defend the local out-of-hours service for not coming out to see a member who was ‘starting with cancer' and explain that a home visit for painless haematuria on Sunday is less helpful than a referral under the two-week rule to urology by your GP on Monday.

All of the group feel they identify with a single doc in their practices who is ‘their' GP. This is the one they will wait to see for something important, but they also feel they can see a doctor urgently on the day if they need to – which reassures me about access. Practice A with a handy branch surgery near the estate is criticised for asking patients to go to its town centre surgery and Practice B likewise rebuked for conversely directing patients to its branch rather than its town centre premises.

As a group, they had a firm grip on the public health agenda and were vitriolic in their criticism of us (‘health') for allowing smokers to stand outside hospital doors. I share their distaste for the vision of pregnant women in dressing gowns and patients towing drip-stands swirling in a cigarette smoke cloud of self-destruction.

Torrential rain had cleaned the pavements such that I could drag a mildly protesting Jane round the windy streets for a tour. While we pound the streets we expound enthusiastically that the people had a firm grip on what was important, that they could spot quality in a service and that it was a reasonable right to have good access to a range of services close to home, but if you needed something specialised you would travel to get it.

‘So you'll come every month?' Jane asked, hugging her thin jacket round her as the rain started again and we dashed to our cars. My reply was blown away by a fresh gust.