>From: "Andrew Herd" <[log in to unmask]>

>PCGs is that the government created them because it
>thought they were what GPs wanted, as a result of listening to the
>members
>of commissioning groups around the country. within limits, the idea of
>PCGs
>does mirror the aspirations of "commissioning" GPs (as they were then)
>quite
>closely.

Yes.
The key differences are liable to be as a result of HAs making secret
preparations, carefullly selecting members of PCG executives,
restricting information, hampering free communication between groups of
doctors and thus taking advantage of interior lines of communication,
and ending up imposing their sort of order on the result.

Does this matter you ask?
Yes.  Because the devious and secretive committee riggers, I can't
curiously neough think of a single actual named example today, will
work with the aim of maintaining their income and power, not of
building an efficient service which is fun for GPs to work in.

We didn't have that in 1996 - according to th emore vocal members of
this list - and it is perfectly legitimate for us to work toward it now.

>No-one knows what anyone wants, 
My LMC constituents - the ones who can be contacted - accept that the
PCG will come.  They evidence a lack of actual enthusiasm, even some
grieving over lost structures of fundholding - which themselves they
accept were unfair and should not hav econtinued as a two tier system -
and a wish to have a smooth transition to something which runs without
too much effortt.
THose of us who are IT capable envisage requiring members of the PCG
administration (which might include people currently working in the HA,
many of whom are well worth employing and can produce big health gains)
to use modern means of communication, instead of wasting our precious
time with meatspace meetings.

We are as an LMC pushing harder for openness in the HA - it seems
unlikely that all those managers who are in meetings whenever the Press
or a GP with a problem calls  are not turning out large amounts of at
least speculation and contingency plans and appreciations, and it seems
desirable that these are exposed to the public gaze (actually that
seems to be part of the white paper ideas)


>I am also interested in all the crap being talked about rationing. As
>GPs,
>we actually connive 
and 
>The issue of overspends appears to me to be a red herring, since
>overspent
>trusts do not cut their consultant's salaries, the vast majority of HAs
>enjoy healthy overdrafts without the sky falling in, and many practices
>have
>got healthy overspends on prescribing and HCHS without anyone coming on
>heavy.

There is a linked problem there, that on the second hand we are
shareholders, and unless we are all sharing the same income pool, there
is likely to be either injustice or a fight.  And on the first hand the
record of GPs in admitting the realities of distribution of work,
income, support and the like as well as rationing of services to
patients, is awful.

>You know something? The more I read this group, the more I think I might
>just give our PCG a try. 
Yes.  TO quote an earlier correspondent "unfortunately, Midge is right" 
welcome aboard.

-----------
Interest:
1.  Singlehanded proprietor of the practice with the lowest per patient
staff reimbursement in the whole HA.
2.  Chairman of the local chapter of the real doctors' union


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