I really wonder what all the fuss is about.

PCGs COULD offer the chance to makethe NHS work by removing the perverse
incentives (its dammed hard to do the right thing) and reward people for doint
it right.

The caveats are :
1. We need to be clear at the outset that this is about improving patient care
and the incomes of those who deliver it.

2. While we may reasonably be expected to account for our use of resources we
must stick on the point that we will never be accountable for their provision.
This is a non-negotiable issue and if not agreed by DoH the whole scheme will
founder.

3. The only source for 1 is the patient care budget.  "Pay & Rations" has to
be ring fenced and can only move upwards in real terms.  We should not be
embarrassed by this and need to be quite clear that it is acceptable for
patients to be denied treatment if the resources to provide it are not
supplied by those (the governent) rsponsible for doing this.  There should be
no question that incomes wouild be sacrificed to provide patient care.

4. The circle can be squared by moving activity and resources from secondary
care to primary care and then working out how to deliver the appropriate care
at lower cost.  The difference finances the incentive structure which rewards
those who deliver the care and also provides for more patient care overall
(and more incentives).  The "average" PCG (100,00 patient) should be able to
release about £1-3M in the first year by doing this.  There is always spare in
prescribing budgets and if the incentives to release this were realistic
perhaps we would here rather less winging about "pressure to prescribe" from
patients.  It is the doctors job to diagnose and advise on treatment.  This
responsibility cannot be abrogated by excuses that patents "demand" treatment
where it is inapropriate.

5 We just need to try harder and if we are adequately rewarded and keep our
eyes on the ball we could do it.

6. I would expect to be able to increase staff pay by 10%, improve patient
care and increase doctors' incomes as well in the first year IF WE ARE ALLOWED
TO DO IT.

7. You may say this is naive but if we are not positive we will achieve
nothing.

Cheer up (or what's a heaven for?)

Michael Blackmore, West Moors Dorset
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