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Tories and Lib Dems still have some wrangling to do over NHS policy

By Richard Hoey

The new coalition partners will have a tricky job reconciling their primary care policies - and their divergent views on the role of GPs in commissioning - says Pulse editor By Richard Hoey

It's been a pretty chummy start to our new coalition Government, with David Cameron and Nick Clegg looking comfortable in each other's company as they posed on the steps of Downing Street.

Indeed, many of the apparent policy differences between the two parties already seem to have been smoothed out, in areas as varied as taxation, education, defence and even to some degree electoral reform.

This though has been an election process in which health has often been ignored, and true to form, there's not been much word yet on the direction the new Department of Health will take, except for the news that it will be led by Andrew Lansley.

Maybe there's been an assumption that this isn't an area with much of a gulf between the parties – but actually there are some quite important differences between the two, and many of them affect GPs.

The Lib Dems have suggested redesigning the GP funding formula to pay practices extra to take on patients from deprived backgrounds – there's no news from the Conservatives on whether they're interested in that idea.

The Tories want GPs to commission out-of-hours services, but the Lib Dems go further, suggesting they'd like GPs personally involved in running them.

Then there's the central Tory plan to redraw the GP contract, handing practices real budgets and ‘putting them in charge of commissioning local services' - much more widely than just out-of-hours.

OK, so the Lib Dems do also say they would put ‘front-line staff in charge of unit budgets' and give them ‘real involvement and a say over how their service is run'.

But that's not quite the same, because the party's manifesto also makes clear it wants to ‘empower local communities to improve health services through elected local health boards, which will take over the role of PCTs in commissioning care for local people'.

Lib Dems fear that an NHS that handed GPs too much power to commission services would not be accountable to the needs of local patients.

But before the squabbles break out, there is a potential solution, which was proposed at a meeting I attended last night on practice federations at the RCGP, just as news of Cameron's premiership was breaking.

The college believes that formal consultation with patients and the wider public will be an essential element of GP federations, which in turn it expects to play an expanding role in commissioning and providing local services.

So, here is a GP model that remains accountable to local patients. It could just keep both sides of our new Government happy.

By Richard Hoey, Pulse editor