Published: 31/01/2002, Volume II2, No. 5790 Page 4

NHS Alliance chair Dr Michael Dixon, a leading proponent of primary care involvement in commissioning, is to stand down as commissioning chair of his own primary care trust.

Dr Dixon is concerned that PCTs are not achieving as much as they would like through commissioning and that national priorities, the effect on acute trusts of diminishing numbers of nursing home beds, and the cost of maintaining existing services mean that there is little money left to bring about changes in service delivery.

He insists that his comments are not meant to be critical of his local acute trust, Exeter Healthcare trust, but a reflection of problems nationally: 'Part of me is feeling that I am achieving less, ' he said.

'When I am meeting the acute trust I do not have the same leverage to bring about the change that many of us know needs to happen.'

And he added: 'It is now time for the people, the health professionals and primary care managers in the frontline to storm the citadel and complete the revolution. They need to become part of policy, not victims of it.'

Bringing around a relatively minor change to the way some cardiac patients are monitored in his PCT took 18 months to deliver, partly because of the problems of freeing up£11,000 to make the change, he said.

Dr Dixon said he is sympathetic to acute trust staff who are 'in war mode' and dislikes having to push them so hard to make changes.

But nationally 'vested institutional interests' are also hampering change, he told HSJ.

'The frustration is the difficulty of getting things moving. Partly it has been money in the past, but also it is really only with the local specialists' say-so that it is happening, ' he said.

'What I would like to do is keep secondary care resourced well and reconfigure at the same time.We should be going hell for leather on commissioning now, ' he added.

Dr Dixon will stand down on April 1, the day the latest health reforms are due move power to PCTs.