On Sat 14 Mar, Jon Rogers wrote:
> On Sat, 14 Mar 1998, Ahmad Risk <[log in to unmask]> wrote on gp-uk
>
> >That scenario, I am afraid, would put in direct conflict with the
> >Health Service Circular
>
> No it won't. Our constitution is for the locality commissioining
> pilot starting 1st April 1998. I expect it will evolve into the PCG
> when more experience and information is available. Even then, the
> "PCGs will be flexible to reflect local circumstances. The approach
> will be bottom up and developmental."
>
> >which states that PCGs should not be formed
> >around existing commissioning groups,
>
> I presume that you are referring to HSC1998/021 which says "it may not
> always follow, for example, that existing locality arrangements will
> provide a suitable basis for Primary Care Groups". That is not a
> prohibition, in my understanding, but does emphasise the need for
> wider consultation as we move towards a PCG.
[snip, a lot more stuff in a similar vein]
The March guidance on Primary Care Groups should be released some time
in . . . March (see timetable in HSC1998/021). It is still under
discussion at the NHSE but should address most, if not all, the points
raised in this discussion. I can't comment on the detail for obvious
reasons but it seems the thing we need to get right first is the
configuration of the Primary Care Groups themselves. Hopefully the
March guidance will help with this. The detail will follow.
In response to Ahmad: we need to realise that we are witnessing the
transition from the autonomous to the accountable clinician. This is
the trend in health care systems around the globe. It is going to be
painful for poorly performing clinicians, but I guess those reading
GP-UK should be OK ;-)
HMOs in the USA have variable clinician involvement, though Clive Smee
(Chief Economist at the DoH) has observed that those with greatest
clinician involvement are the most successful. It is perhaps no
coincidence that in the UK GPs are being offered a real voice in how
the Primary Care Groups will develop.
I think we are being offered a simple choice: manage or be managed.
--
Dr Ian Trimble http://www.sherwood.demon.co.uk/
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