I agree with your editorial that the Government should have piloted commissioning before pushing it on GPs.
(Let's learn lessons from flaws of PBC)
Practice-based commissioning failed through the lack of interest of both PCTs and GPs. I find nothing in the words of health secretary Andrew Lansley or primary care tsar Dr David Colin-Thomé to suggest that GP commissioning will be sufficiently flexible to generate enthusiasm from GPs.
My view is to the contrary, having seen the bitter failure of our PBC group. To force GPs to work together and to form consortia in a rush is to fail to learn from past experience.
We were constantly told PBC would be driven from the bottom up. It never happened and will not happen if commissioning is thrust upon GPs.
The white paper does not tell us what the incentives will be for commissioning - or what the penalties will be for GPs who do not commission. In my view, we should do our jobs as GPs and secondary care should do its job - which means managing patients without them having to be re-admitted, investigated and sent back to GPs.
If all these things happened, commissioning as a formal activity would not be necessary.
Last week we received email and hard copy versions of a 42-page report from the PCT performance and information directorate on de-commissioning and disinvestment. I am sure this must be happening in other PCTs - but what a complicated and bureaucratic set of instructions. When PCTs cease to exist in 2013, will we carry on with the same legacy of paper production and endless circulars?
From Dr Krishna Chaturvedi
Southend-on-Sea, Essex
