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The NAPC annual conference 2010: As it happened

Read minute-by-minute coverage from the Pulse and the Practical Commissioning team at the 2010 NAPC conference as it happened.

Tuesday 19 October

16.15 Welcome to Pulse's liveblog for the 2010 NAPC annual conference. With health secretary Andrew Lansley, NHS chief executive Sir David Nicholson and GP commissioning tsar Dame Barbara Hakin among those scheduled to appear, we look set for a busy couple of days in Birmingham.

If you're planning to attend, drop us a line at or on Twitter @pulsetoday and let us know what you're hoping to get out of the event. If you're not, you can check out the agenda for the next two days and see what you'll be missing...

Wednesday 20 October

05.00 Sue McNulty (Practical Commissioning editor): Brrr it's three degrees outside according to my thermometer. Wonder if it's colder up in Birmingham today.

06.00 Sue McNulty: Declutter my handbag before I leave to catch train to NAPC conference. Find four-year-old daughter's fairy wand at bottom and put on 'file' pile but then decide to take it with me in case I need some magic over next two days - train delays, laptop crashing. I'll give it a little rub and see...

07.00 Sue McNulty: About to board train when realise my ticket is first class! Sure it was cheapest ticket when I booked last night. See, better quality doesn't necessarily mean more expensive - as good commissioners will know. Hotter than a neonatal ward on here.

Or did my magic wand turn my ticket from standard to first?

07.50 Sue McNulty: Time to listen back to conference I went to yesterday organised by Westminster Briefing. Dr Jennifer Dixon of Nuffield Trust's presentation was really interesting. She showed a graph with a sharp incline of emergency admissions overtaking illness levels. The next slide shows how much one night admissions have gone up even though hospitals are getting better at reducing the number of multinight stays.

'What is going on here?' she asks. 'What we think is happening here is if you reduce length of stay you effectively free up bed capacity to help at the front end.' She goes on to say how having worked in A&E and with a patient that is a 'little bit risky' at 10pm when you don't know what support they have at home it is easy to admit them - if there's a bed.

For me, this is a theme I hope will emerge from the NAPC programme: how do we stop squeezing the balloon without making a big bubble at the other end?

08.48 Sue McNulty: Frost on the fields as we leave Coventry. Listening to more from my dictaphone and Steve Field's speech yesterday. He makes the point that these reforms planned by Andrew Lansley were happening long before we hit the financial crisis, so rather than politicians trying to 'stitch up' GPs he believes there is a genuine will from the Government to see GPs take the reins. He also talks of health inequalities - 60% of Irish travellers die before aged 60. Looking forward to Mike Grady's presentation tomorrow on how to tackle inequalities in lean times.

10.00 Day one of the conference is just about to get underway with a welcome from NAPC chair Dr Johnny Marshall.

10.21 And we're off... Dr Johnny Marshall has just kicked off the conference with an upbeat message. Two and a half years is enough time to get GP commissioning off the ground, he says.

10.40 NHS chief executive Sir David Nicholson has just said the management allowance amount - 'the magic number' - will be in the DH operating framework out in December.

11.00 Gareth Iacobucci (Pulse reporter): NAPC chair Dr Johnny Marshall was his usual bullish self as he opened the conference, calling the Government's GP commissioning plans a 'once in a generation opportunity'.

He strongly rebutted criticism that GPs might not have the capacity or capability to take on commissioning, insisting that doubters had 'missed the point'.

'It's not all about GPs,' he said.

11.05 Gareth Iacobucci: Sir David seems much more positive about the commissioning plans than he perhaps has been previously.

11.30 Sir David Nicholson has warned GPs they will have to make sure they retain the best PCT staff to work in consortia in order to make commissioning a success.

'There are some tough decisions right now,' he said. 'If consortia decide to use services of none of the people in PCT, that leaves us with a bill of £1.5 billion pounds. The only place that can be paid from is the consortia allocation to consortia and PCTs. But if you take them all, it will cost nothing, but it won't deliver the change.'

Read the full story: Nicholson: Consortia must take 'tough decisions' and hire best PCT staff

12.15 Sue McNulty: Grrr, my blackberry died. Where's that wand? More from Sir David earlier - to get rid of all PCT staff would cost £1.5 billion.

You should avoid 'self-appointed GP leaders sitting in rooms with maps - that's how you create PCTs', he said. If focus too much on form and governance 'we will lose the plot of what this is all about', eg better care, service redesign focus. The consortia nuts and bolts can come later...

13.20 The conference has now broken for lunch after a busy morning.

13.25 Sue McNulty: Just sat in on Dr Peter Cutler's 'economic reality check' - really good stuff but standing room only.

He said we should prepare for cuts in NHS budgets in years to come, so why not renegotiate contracts with providers now even if the contract has not ended?

'The private sector renegotiates contracts all the time,' he said, urging commissioners to be much more demanding.

'Nirvana' will be a combination of NHS and private providers, he said, adding that if you've got a DH acting like a monopoly start nibbling at the edges - they'll soon get the message they have to change.

14:30 Practical Commissioning editor Sue McNulty has now written a full story on Sir David Nicholson's comments about the management allowance - see: GP consortia management allowance to be announced in December

15.45 Gareth Iacobucci: In a discussion on the whole commissioning agenda, NAPC member and Kingston GP Dr Charles Alessi says he has 'had enough of sodding structures'. Haven't we all Charles...

17.00 Sue McNulty: Just been in the health inequalities session with Mike Grady. Saw two really good videos of how community health champions work in the community.

We saw 'Scary Mary' who is the health champion in a local community centre and would certainly focus my mind on shifting half a stone with her no-nonsense approach.

Then we heard from two more community health champions in Sheffield - how refreshing to hear local people talking about giving up smoking, help with drugs etc rather than clinicians.

The icing on cake for me though was that what they've done has been analysed by Leeds Met university and shown to do those two magic words for commissioners - reduce admissions. Too often schemes are set up that don't work and the call for outcomes to be stronger can only improve things.

One last statistic - out of 115 CHCs, 36 are now in paid employment, an outcome that wasn't anticipated. You wonder if health champions are worth appointing for that outcome alone.

22.00 Sue McNulty: Really good awards dinner coming to a close. The host Dr Phil Hammond was on good form - and even shared some enthusiasm for GP commissioning at the end.

23.55 Gareth Iacobucci: Senior NAPC figure (who shall remain nameless - Ed) spotted ripping up the dancefloor at five to midnight. World Class Positioning anyone?

Thursday 21 October

09.06 The day begins with a breakfast briefing from Health Committee chair and former health secretary Rt Hon Stephen Dorrell MP. Mr Dorrell spoke of his frustration that Tony Blair regretted getting rid of fundholding. But he also said that he had some satisfaction that the purchaser-provider split is now accepted.

10.05 GP commissioning tsar Dame Barbara Hakin has just spoken - and appeared to quash the NAPC's wish for consortia to hold GP contracts, asking 'Where's the probity, checks and balances?'

She also said there would be 'no more guidance' from the Department of Health on how to set up consortia, and that it was up to GPs how they develop.

12.00 Health secretary Andrew Lansley announces an extra £1m investment for 'pathfinder' GP consortia' to take on early responsibility for commissioning. Practices have until the end of October to apply.

12.30 Full story on Andrew Lansley's keynote speech is now up on the site.

14.26 Sue McNulty: Good question from GP about whether the PROMs forms are just completed by the middle class with good literacy. Good answer - available in 15 languages and can be completed by proxy. Pilots showed response rate of 80-90%.

14.50 Could PCTs and SHAs get a last-minute reprieve? Definitely not, Andrew Lansley told Pulse this morning in an exclusive interview with Gareth Iacobucci.

He also talked about the Comprehensive Spending Review's impact on the NHS and the BMA's stance on the white paper and GP commissioning plans. Watch the full video here.

15.30 There is enough waste in the NHS to keep making efficiencies for five years, says Dr Oliver Bernath, managing director of Integrated Health Partners in a breakout session on HMOs. 'Ten years,' shouts out NAPC chair Dr Johnny Marshall.

16.27 Sue McNulty: 'We' are the ones responsible for the demand tsars, says Nigel Edwards of the NHS Confederation. 'If you build they will come.'

Chimes with my posting yesterday - bed stays shorter but one day admissions have pushed the overall number very high. Why? Because A&E docs have got beds to refer into now.

Had good chat with GP at lunch. Group of consultants still work in his practice as a legacy of fundholding but the acute trust won't allow them to directly refer to diagnostics and they have to make an outpatient appointment first where they see the same patient again. So that's £70 on an outpatient appointment to talk about where they are going on their holidays or Wayne Rooney's departure. What a waste!

16.45 Sue McNulty: PROMs measure how providers have value-added to patient care in the same way schools have a value-added scrutiny under OFSTED. Didn't know that. Think it's good the hospital in the leafy suburb has to show it's improved just as the inner city one has to.

17.58 Sue McNulty: Conferenced out! On train home, no rest though for some of the UBM Medica team who organised this year's conference - they're off tomorrow to find a bigger venue for next year.

18.00 The conference has closed, the delegates are heading home - that's all folks. But don't forget you can access a full round-up of news, analysis and video on our special NAPC conference page. Thanks for reading.

Click here to view our special NAPC conference page NAPC annual conference 2010