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Gerada will bring a new edge to college role

A seamless transition this one is not.

No one is going to confuse Dr Clare Gerada for her predecessor as RCGP chair, Professor Steve Field, and not only because they are so strikingly different in looks.

Professor Field was a consummate politician, rarely putting a word out of place. He was the high priest of constructive engagement, never making a grandstanding speech where a quiet word behind closed doors would do the trick.

Dr Gerada is a different beast altogether. She is a tenacious, robust, outspoken streetfighter, closer in spirit to GPC chair Dr Laurence Buckman than to Professor Field, with a habit of flinging words around with a twinkle in her eye.

Such a marked change in leadership will inevitably affect the stances the college adopts, the ways it is perceived and the influence it wields. How then will the transition from Professor Field to Dr Gerada affect the ability of general practice to make its voice heard, and in particular, how will the health secretary, Andrew Lansley, respond to a new challenge from perhaps unexpected quarters?

Certainly, Dr Gerada is likely to benefit from the progress the RCGP has made in its three years under Professor Field. He has not been combative enough for some tastes, but he has imbued the college with a sense of authority it has not always carried in the past.

And when he has spoken out strongly against government policy – on GP training, out-of-hours care and Darzi centres – his words have carried the weight that comes with rarity. He has been the RCGP chair who only occasionally cried wolf.

But this is a good time for the transition. Professor Field's enthusiasm for GP commissioning had begun to sound out of step with the rest of the college. When he gave the white paper an effusive welcome back in July, eyebrows were raised among some RCGP members.

Constructive engagement is the North Korea strategy, valid when working with Labour politicians who so often appeared suspicious of GPs. But there are real questions over whether it could have much traction with a health secretary whose key flaw is perhaps that he has such heroic faith in GPs' abilities, without an awareness of the constraints upon them.

Our interview with Dr Gerada highlights her concerns on a broad range of issues. But if she wants to have influence, she must refine her message to focus on what really matters to GPs and patients.

Her support of our A Clean Slate campaign to keep GPs free of PCT debt is welcome, and the BMA has a big job ahead in ensuring the contractual mechanics of commissioning are right, so it is attractive rather than punitive.

But many GPs will want her, as college leader, to concentrate on those areas of government policy with the greatest impact on the professional integrity of general practice.

In particular, she should focus her fire on the Government's plans to dilute NICE's role and scrap practice boundaries – not least because they are so obviously at odds with each other.

These are weak points in the Government's armour, and Dr Gerada must bring the college's new-found combativeness to bear upon them.

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