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A chance to exploit the political vacuum

The profession may feel unsettled while we have a hung parliament – but it could be an opportunity for GPs to take back the lead in clinical decision-making

A tense, tight and disorientating election has delivered Britain into uncertainty. As Pulse went to press, the final outcome remains unclear, but the Conservatives appear to be inching towards a coalition.

But a new Tory administration that does not rule with a clear, undisputed mandate may struggle to implement the full force of its programme, including NHS policies.

The focus is likely to be on the economy, and on weighing short-term political advantage in preparation for a second election within a year, rather than on a new GP contract or on a shake-up of NHS targets.

And if there is a lack of momentum for a change in approach to primary care, that will come as a blow to those GPs who have become frustrated by the departing Government's top-down approach to NHS management, and in particular by the latest attempts by primary care organisations to force through efficiency plans without consulting GPs.

Pulse this week reveals that trusts are turning to evermore desperate measures to make cuts, with several implementing absolute caps in the number of GP referrals, and requirements for every single referral to undergo a vetting process by the trust before being given the go-ahead.

If that is a snapshot of present trouble, we also reveal a model for a potential alternative future. A GP consortium praised for its approach to commissioning by the likely health secretary Andrew Lansley has developed radical plans to pool the entire primary care budget for elective care with the local acute trust.

Under that vision, GP referrals would not be dealt with by the PCT. Rather, it will be in the joint interests of the practices and the trust to agree how to rationalise activity.

The plans also contain a typically Tory, and potentially less popular, twist. Among the stakeholders in the combined primary and secondary care budget would be a new independent sector treatment centre, designed to provide a range of commercial services, operated in the community.

The price of freedom from managerial targets would be, it seems, the expectation that GPs snuggle up with the private sector. Then again, that future of high stakes but potential profit may never happen. A new government may lack the will or power to push through new legislation handing budgetary control to practices.

If GPs are unhappy with how the health service is being run, they will not rely on politicians to put that right any time soon. Still, it's too easy to see political uncertainty as a problem. It could very well be an opportunity. For once, ministers may not be relentlessly focused on implementing their grand theories and simplistic visions.

PCOs, free from political edict, may be more open than usual to innovative, practical ideas from the front line. A political vacuum could, for general practice, be an empty stage. And GPs with ideas and drive could just be ready to fill it.

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