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So this is what GP engagement looks like

A total of 770 elected positions in 94 areas, and just 53 contested. Position after position waved through with a nod of a chairman's head. You might imagine you were reading the latest ballot results for Communist party committees across the People's Republic of China. Or perhaps civil service minutes recounting how reluctant volunteers had filled vacancies for fire wardens or first aid reps.

But think again. The results relate to elections for GP board members of the prototype clinical commissioning groups (CCGs). The successful candidates are the men and women (but mostly men) who will represent general practice through this critical period in the development of the Government's NHS reforms, and are already taking critical commissioning decisions on behalf of the profession.

It is extraordinary and alarming that GPs have been appointed to CCGs with so little mandate among grassroots members of the profession.

When the GPC called for elections at commissioning groups across England, it must have assumed that, in the tradition of 21st century Western democracy, ballot papers would tend to be populated by more than one name. That they have not been is damning of the selection process and a blow to the Government's claims that the new bodies will represent, and be owned by, ordinary GP practices. What is less clear is who is to blame, and what can be done about it.

Shallow engagement

There are two possible reasons why 93% of all elections for GP board positions were uncontested, and neither make comfortable reading for those who hope the reforms will involve the whole of general practice.

Under the first scenario, barely any GPs were interested in joining their local CCG boards, perhaps because they were too busy, too sceptical about the value of the Government's reforms or too daunted at the responsibilities ahead.

If that is the true reason for Pulse's findings, it suggests GP engagement with the new-look NHS is far shallower than ministers might like to claim.

There is also another, perhaps even more concerning scenario. Could it be that in some areas, CCG board positions were advertised in an obscure corner of the PCT website, or in newsletters circulated only to commissioning enthusiasts, or at meetings where you had to be invited to attend?

In some areas, GPs have complained that awkwardly timed board meetings were impossible to fit with their family lives, or even about active efforts to dissuade those from outside the commissioning cabal from getting involved – areas, for instance, where GP locums are excluded as a matter of policy. What is the chance that the CCG leadership will engage grassroots general practice in these areas?

The GPC has already made clear CCGs must repeat elections when they take on statutory responsibility for commissioning. But in areas where elections were not properly and openly advertised or positions open to all, that is too long to wait. There, CCG leaders should take a long, hard look at their selection process, and if necessary repeat it.

It's essential elections are run properly because this is a critical test of GP opinion. On the face of it, it looks as though GPs have been asked whether they want to involve themselves in commissioning – and have voted, in damning fashion, with their feet.