>the era of clinical freedom has long gone. The attitude of "I am the
doctor,
>no one can criticise me, I decide alone" was never valid and always hid a
>multitude of lousy doctors from their peers.
>You rightly want rationing, but how can you have evidence-based 'rationing'
>(better word is care) and allow docs complete clincial freedom?
>Yes, PCGs might fundamentally alter us. Who ever said that how we practise
>should never change?
>GPs hated the introduction of the NHS, saying clinical
>freedomthreatened/mega-state/communism in disgise etc. we have always
objected
>to change of any kind, yet still moan about a present circs (rising demand,
>less time, poor pay and conditions). Change or stop moaning!

I agreed with all that until the last sentence. The point is that the were
elements of the
old system that encouraged innovation, and there was also a growing tendency
for practices
to club together where a common interest for the patients could be
identified. It was the
previous administration that enacted the legislation for PCAPs, multifunds
etc. JCGs were talking
to health authorities before May 1997.

I suggest that it would have been pragmatic to allow these disparate models
to evolve, and
learn from their experience, rather than starting again with a clean sheet
of paper, and
introducing concepts such as single budgets to cover GMS and patient
services. If you read the
Labour party policy documents before the last election (as I did) you will
know that
pre-election they were talking about "Locality Commissioning Groups". Only a
small part of the current
plan is to do with commissioning.

Any sensible professional person should expect continuing change. I am
moaning
about the fact that we are being handed the stewardship of a revolution,
when most of us wanted
a period of stability or gentle evolution. Fundholding solved a lot of
problems for my practice and
created many well-appreciated opportunities. Why shouldn't I moan if the
replacement looks worse?



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