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Spiderman’s warning for GPs as they take political centre stage

If commissioning plans go ahead, GPs can expect to face intense scrutiny, says PulseToday editor Steve Nowottny

So, it looks like Mr Lansley's grand commissioning plans are going to come to fruition after all.

There was a definite wobble this week, as Pulse editor Richard Hoey noted in his blog yesterday, with Treasury doubts over the costs and even the most pro-commissioning GPs raising fears over a blanket rollout.

But reports in the national papers today – reports are all we have to go on given that the story was originally leaked to the Telegraph by unspecified secret sources – suggest that it's full steam ahead.

At 3.30pm on Monday afternoon, the health secretary will give an oral statement to the House of Commons outlining the detail of his White Paper. It's expected to mean a new GP contract, including compulsory commissioning responsibility and tough accountability measures, the scrapping of PCTs with tens of thousands of redundancies, and around £80 billion of the NHS budget being handed directly to family doctors.

For once, the banner headline heralding the ‘biggest revolution in NHS for 60 years' doesn't really seem to be an exaggeration.

Of course, crucial to the success of that revolution will be the response from the GPC leadership. But with the caveat that they've yet to see the detail, negotiators have so far been remarkably positive.

As Dr Chaand Nagpaul told us this week: ‘GPs are fed up at having token representation on PCTs. What Mr Lansley has proposed would give us real influence.'

Of that there's no doubt – but real influence could prove to be something of a mixed blessing. At a time when the public sector is preparing for savage cuts across the board, any group suddenly handed responsibility for £80 billion is going to find itself under the most intense scrutiny.

Take this line from the Telegraph's front-page story this morning: ‘It is understood that Mr Osborne has been assured by Mr Lansley that there will be safeguards in place to ensure GPs do not "waste" the money.'

The perception remains in some quarters, rightly or wrongly, that GPs simply aren't up to the task of handling such huge budgets. (Others, such as the Jobbing Doctor's colleagues, might argue that commissioning isn't why they went to medical school and they're simply not interested).

When, almost inevitably, local stories emerge about blown budgets and tendering overspends in Ruralshire or wasted investment in Somewheretown… well, no prizes for guessing who's going to get it in the neck from the Daily Mail.

There's no doubt that Monday's White Paper represents a huge opportunity for the profession – and it could just manage to kickstart a genuine revolution in the clinician-manager relationship. But as a certain comic superhero was once told, ‘with great power comes great responsibility'.

And if it all goes wrong, expect great blame as well.

Steve Nowottny is the editor of PulseToday.

PulseToday editor Steve Nowottny PulseToday editor Steve Nowottny