The greater detail due to be set out in guidance on primary care groups within a matter of weeks - and reported in HSJ's news pages this week - suggests that ministers and civil servants have listened and taken on board many of the concerns voiced by the NHS (see News, page 2).
Around half of the entire document is devoted to ensuring that PCGs can be held to account financially and organisationally. For all that health authorities will have little more than a token presence on PCG boards, there will be other strong controls. PCG chairs will be answerable to the chief executive of their HA, who in turn will remain the accountable officer for every PCG in their area; schemes to delegate financial authority to PCGs will have to be explicit about the responsibilities they entail; and each PCG will be required to reach an annual accountability agreement with its HA, and to publish details of how that agreement worked in practice in an annual accountability report.
All of this is good news. So, too, is the promise that PCG boards will be able to broaden their membership by co-opting, among others, finance and public health managers. The three-year limit on board membership, too, is a sensible constraint which should help prevent boards being dominated by cliques, while the commitment to ensure PCG boards meet in public is more than welcome - for all that we should expect no less.
But does it go far enough - and how will the other anomalies thrown up by the guidance be dealt with? Perhaps not surprisingly, co-opted members will not be allowed a vote - will groups such as the professions allied to medicine who have shouted so loudly at their exclusion be satisfied with the right to comment from the sidelines? Why, when HAs must make do with a single non-executive member on PCG boards, will social services be expected to nominate an operational manager rather than elected councillor? And is it in any event realistic to expect HA non-executives to find the additional time all this will entail when no one has so far suggested that their duties do not currently fill the time for which they are paid?
Will PCG board members elected by constituencies made up of doctors, nurses and other practice staff really be able to commit themselves to the 'corporate approach' required both by common sense and the guidance document? There will certainly be times when the tension between the two becomes simply unmanageable - and those times will undoubtedly be precisely when the need for a strong corporate approach is most necessary. The spectacle of GPs leaping overboard, either individually or collectively, at the first sign of financial problems is likely to become a regular feature of the New NHS.
There must be some concern, too, that the model standing financial instructions and standing orders to be issued later this year will not be mandatory. If messy disputes about probity and financial control are to be minimised, the rules should be as prescriptive as it is possible to be. Surely that lesson, at least, of the buccaneering and under-regulated early 1990s has not been forgotten already.
If health minister Alan Milburn's by now infamous letter to the British Medical Association ceding control of PCGs to the doctors represented the headline message, then this circular sets out the small print. It contains the previously unspoken caveats which simultaneously make the BMA's victory more palatable to the rest of the NHS and less 'liberating' for the doctors than their negotiators might have hoped.
It provides answers to questions that that agreement raised, while itself raising further uncertainties.
But assuming there is no major change in the content of the circular between now and its official publication, it takes a considerable step towards making PCGs a workable proposition.