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Pause? What Pause?

The health bill may have been on hold, but for a GP commissioner on the ground like our diarist, there is no slowing down.

The story so far

Dr Peter Weaving is a GP and locality lead in Cumbria, hailed as a trailblazing example of what GP commissioning can achieve by health secretary Andrew Lansley. Our diarist is nonetheless feeling reality bite, with some local consultants voicing strong concerns about proposed changes and the commissioning pace not letting up…

As the health service waits to see what its future will look like and with no inkling what colour smoke will issue from the Government's chimney as I write this, I might have been forgiven for assuming we would have a little rest. No breather for me; a kaleidoscope of meetings, events and encounters rushes by.

I'm being pursued by a secondary care clinician, a professor no less, who continues to challenge my financial description of the local health economy. Our graphs of activity and expenditure are mirror images – his go up where mine go down and vice versa. He's increased his operating year on year and I can't find a free slot on Choose and Book.

Next I'm sitting on a committee that is considering the options for the future of a hospital trust. The most likely outcome is the merger with, or acquisition by, a willing foundation trust.

The chief executive of a large FT that might acquire or merge with the hospital describes how he would deal with an errant clinician: ‘You get the odd stray cat that has to be dealt with. You show a bit of white knuckle. People fall back into line.'

I began to wonder what our commissioning meetings would be like.

At a time when we have been pared to the bone to try and break even, FTs are allowed to sit on millions of pounds of profit. Sorry, not allowed to say ‘profits', I mean ‘operational surpluses'. Now how is that any different to what a commissioning consortium or fund-holding group does?

After a frantic year, and as the dust settles on the year-end position, I am astonished to see really impressive reductions in hospital emergency admissions. I wish those had been paralleled by a commensurate fall in cost, but at least the model seems to work.

As the Month 1 (ie April) data rolls in for analysis, the merry-go-round of cost and performance spins into the new financial year and drives us to go up a gear on plans for service modernisation. In spite of the organisational stress going on, the practical operational meetings with local consultants are good-natured, productive and humorous.

Into this mix, let's toss our own elections – GP commissioners securing a real mandate from their clinical colleagues. Even the relatively straightforward concept of ‘one man, one vote' is questioned by some of the GP electorate, with an alternative suggested of a vote proportional to the number of patients you see.

For the record, we're going down the route of a single transferable vote; localities of about 100,000 electing five executive

GPs. You need GP experience to stand and everyone on the local performers list can vote. The six locality executive committees each elect their chosen representative to sit on an over-arching group, which meets to lead the decision-making on pathfinder issues. Localism and joined-upness, we hope.

Finally in this spinning melange around me I find my editor's deadline. Oh joy.