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Stick to your guns, Mr Lansley

As the pressure grows on Lansley to tone down his commissioning ambitions, Practical Commissioning editor Sue McNulty argues he needs to stay on track

There's a new phrase on the block – alpha GP.

Alpha GP has got business know-how, is the one in the practice who prints off the spreadsheets, has possibly already won a contract to provide a service to the NHS with that little sideline company they're a director of. Oh and they actually really understand what's being said at a LMC meeting.

Don't overestimate what the average GP knows about life ‘out there'. When the GP contract negotiations were going on some ten years ago I had to explain what GPC stood for to one group of GPs sat next to me at a contract roadshow. Their eyes were still a bit glazed when I said it was the GP committee of the BMA.

At another roadshow a GP stood up and ranted at the GPC bods as if they were from the DH. The audience went into a sort of half-clap as they agreed with what the GP was saying but sort-of thought he'd got the wrong guy. It was a bit embarrassing really.

Anyway the argument goes that Lansley is surrounded by alpha GPs and that those GPs (see above) who have no interest in commissioning won't be able to cope and the brakes need to be put on all this GP commissioning lark. Instead the alpha GPs should all do a pilot and then the rest of us can learn from their successes and mistakes.

Part of the build-up to the call for the brakes to be put on, was Sir David Nicholson saying PBC groups would score a ‘three out of ten' if rated.

I'd like to ask Sir David what rating PCTs would get.

A senior member of one of the country's leading consultancies recently told me he'd been to a PCT and ‘found nothing of any value' being done by the staff.

How much have PCTs decommissioned? The answer is a BIG FAT ZERO. They are too scared to do it and operate in a culture where their focus is not to do anything wrong, instead of looking at how to make things right for patients.

Lansley is onto this.

He cites NHS London as deciding eight providers were necessary for hyper-acute care for stroke. He has spent months asking where the number eight came from and the only answer he's been able to get is that they don't have enough stroke physicians and nurses. Maybe so, but why eight. Why not six, or even better 10 - all on a 'any willing provider' contract?

Back to GPs. There's a spectrum here. Alpha GP at one end, head-in-the-sand ‘I need a acronym-buster' at the other.

It does make sense to let the former fly BUT there must be a way to engage the latter.

Commissioning decisions are made in the consulting room every day. The era when GPs operate in silos – only consulting their GMC regs or NICE guidelines to ensure they're within limits - are over. Added to it must be a sense of responsibility to the local budget and service redesigns their colleagues are trying to get off the ground. The QOF is the obvious tool ready to hand to do this.

Engaging all GPs in commissioning is the only way to sustain the NHS to still be free at the point of contact.

And the desire to keep that principle sacrosanct runs across the spectrum.

editor Sue McNulty