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We are sleepwalking into a commissioning catastrophe

There may be an enlightened majority of GPs excited and enthused about the brave new world post-white paper. The Jobbing Doctor just hasn't met any of them yet...

Sometimes I seem to practise medicine in a silo. I go into work, I see my patients. I read my post, I check my test results. I go home.

It is somewhat rare for me to have the opportunity to talk about the bigger picture, and I don't know if my views are unique to me, or an expression of a wider view. GPs can sometimes be very isolated.

There are times, however, when I meet up with my friends from a broader swathe of the region. When we do meet, we sometimes talk about the big issues that face us in our jobs.

Important issues like the biggest managerial change in the NHS in my professional lifetime. That is the advent of GP commissioning. This huge upheaval is likely to go live next year, and we will be swamped by additional responsibilities and tasks that, I have to say, we are entirely unprepared for. I wonder if I am a miserable troglodyte, grumbling in my cave, and out there the enlightened many are seeing this whole change as a new opportunity.

I asked my friends what their take on commissioning is. They were all pretty non-plussed. I was told that there was little support for the changes, that we were unenthusiastic, and entirely unskilled for the job. The task was huge, and fraught with difficulties, and really not do-able.

I agree with them, and think we are sleep-walking into catastrophe. It does not feel like a good prospect to the Jobbing Doctor.

One of the roles that we fulfil best of all is that of a patient advocate. They come to me asking if they should take their new tablets, or whether they should proceed with their operation, and I will tell them what I think they should do. They believe me, because they trust me.

But will it be different next year? I think it will.

Firstly, we will be set up to be the fall guys. 'Mrs Brown, you can't have this particular treatment,' the consultant might say 'because it hasn't been commissioned by your GPs'. All of a sudden we will be changed from trusted adviser and supporter into the rationer and denier of treatment. That will not feel good to me.

Secondly, all our opinions will be undermined by the fact that the patients believe that we simply want to save money. They will think I won't refer because I want to save money, rather than the lack of reasons to refer. This, combined with the usual stories of rich GPs who refuse to work at night and at the weekends and take home eye-watering amount of income, will undermine people's trust in us.

No, my colleagues (who are all high up in educational circles) are not keen at all.

Can we do anything about it now? Will complete inertia be the best policy? I'm not sure, because then the Government will hand commissioning to private companies to run, and commissioning decisions will have to be made by a board of GPs (and we'll be blamed by any special interest group if certain things aren't available).

If we decide to support the policy enthusiastically, we will be caught with the same problem. A lot of spending decisions have already been made, and many PCTs will hand over a deficit to the commissioners.

Those who operate on the strategic level, once again, have not thought it through.

The policy is a complete turkey, but the people who will be roasted will be the GPs.

This is not a tempting prospect.

The Jobbing Doctor is a general practitioner in a deprived urban area of England.

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