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David Stout: Avoid losing sight of the financial challenge ahead

The new system of commissioning cannot simply be a replication of work PCTs currently do.

There is no doubt that the health White Paper means big changes for the NHS generally, and for GPs in particular. While it is going to be a challenge to meet the expectations laid out by the government, getting to grips with the implications of the new world is essential.

There are still lots of issues to be clarified, critically what the management allowance for GPs will be and how accountability for the GP consortia will work. But this is not a reason for inaction - the focus on change must start now.

Early discussions between PCTs, GP consortia and local authorities are necessary to start working out how the new system should work and to ensure we continue to improve quality of healthcare and retain financial control during the transition.

It is clear that the new system of commissioning cannot simply be a replication of work PCTs currently do. However, GPs recognise that there are many skilled managers in PCTs who can help with new implementation.

As the NHS enters its most financially challenging period, difficult decisions will need to be taken about the funding and provision of certain services. This will require close working between those in clinical and managerial positions as the responsibility for commissioning moves over to GP consortia.

Feedback from Pulse's own survey suggests that discussions are developing; one in four GPs says they have begun talks with their PCT about increasing their commissioning responsibilities and efficiency plans. This suggests that both GPs and commissioners are making an impressive start to the major reforms asked of them.

While it would be easy to focus solely on the design of the future, we cannot afford to lose control of finance or quality before the new system is put in place. We should continue to press for clarity on key issues laid out in the white paper, but not lose sight of the biggest challenge of all; finding £15-20bn savings in the system during the next five years.

David Stout is director of the PCT Network at the NHS Confederation

David Stout, director of the PCT Network