If a commissioning revolution is vital to making a success of the new NHS landscape, we must know who will be making the decisions. In too many cases members of primary care trusts' professional executive committees have found themselves - or placed themselves - well away from the issue.
This is set to change, or at least that is the belief of the NHS Alliance in its consultation document for the Department of Health published today ( read more≫≫).
Its argument, based on stakeholder support, is for a new type of PEC which is in effect part of the board of the organisation. PEC members will have specific roles and be paired with executive directors, rather than being free-floating representatives of a particular local clinical group. No longer will it be the 'House of Lords, a talking shop', as the alliance's Dr Michael Dixon describes the old system.
As the document delicately suggests, PECs have had a 'variable' history - and PEC members have been as critical as any. How many of those currently serving on PECs will make the transition?
In the case of chairs, probably a majority will be old hands, but there will definitely be a churn.
This is particularly the case where PCTs will want to ensure that practice-based commissioning leads are represented. Although the alliance stresses that there should not be a single model, it seems difficult to envisage a new PEC working well without heavy direct involvement from practices actually doing the commissioning.
Although consultation is now ongoing, the alliance seems confident that it has accurately gauged the mood. So if the 'clinical executive' does prove to be the new model, the next question is how will their success be measured? The paper suggests that one of their main roles will be 'managing the market' - over the next two years there will be no more stringent test.