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We need an NHS plan B that can unite GPs

It's High Noon for the health bill, and GPs are facing off using the profession's weapon of choice – the formal letter. Dr Sam Everington, the former Labour adviser who famously lent his support to the Conservatives' plans on GP commissioning before the general election, fired off the first salvo last week, with his Tower Hamlets clinical commissioning group issuing a shock demand that the health bill be scrapped. A second CCG, City and Hackney, followed suit shortly afterwards, before leaders from more than 70 CCGs clubbed together to deliver a forceful riposte in the Times, insisting the Government must hold firm. Not to be outdone, the GPC wrote to all members of the profession last week, joining calls for the health bill to be withdrawn.

The week's events might simply feel an extension of a row over the health bill that has blazed for more than a year now, but in fact they together represented a significant development. No longer can the argument over the NHS reforms be characterised as a clash between those GPs who are enthusiastic about commissioning and those who are indifferent or opposed.

It is clear from the actions of Tower Hamlets and City and Hackney CCGs that some active enthusiasts for commissioning are strongly opposed to the health bill, arguing it is unnecessary and could make GP commissioning harder, not easier.

The GPC's move, too, is significant – more so than it might at first seem. Yes, the wider BMA had already called for the bill to be withdrawn, but the GPC has always had a substantial pro-commissioning streak and until now had been unwilling to opt for all-out opposition. GPC member Dr Helena McKeown called the new stance ‘a massive step'.

So where does this leave general practice? Divided, certainly, but not in quite the way it was before.

There are now three distinct groups of opinion – GPs actively opposed or wholly uninterested in commissioning, and by extension opposed to the health bill; GPs who are for commissioning, but against the marketisation, bureaucracy, disruption and costs of the bill; and a staunch, if shrinking, band of unashamed health bill enthusiasts. The bottom line though is that the Government has nothing like the support among GPs it needs to make the NHS reforms work.

It is time, therefore, for a plan B – a plan that abandons wholesale injection of competition into the NHS and substantially modifies proposals for GP commissioning. It is unsustainable to impose commissioning on the profession against its will, incentivised by the dirty money of the quality premium. But neither is it an option to row back from CCGs, which are now the de facto decision-making bodies in many areas of England, and in some have given GPs a strong new voice.

CCGs need to be formally enshrined within the structure of the NHS, in a way practice-based commissioning groups never were, but without statutory powers for rationing or it being mandatory for practices to take part. Only a plan B can make sense of this frantic letter-writing campaign, and finally get all of general practice back on the same page.