There will be considerable relief that health minister Alan Milburn has set the salary scale for primary care group chief executives at a realistic level (see News, page 4). The individuals appointed to these jobs will be crucial to the success of the whole PCG project, and it is vital that they carry the necessary clout to deal with the doctors on their own level if we are to avoid a descent into the chaos that would ensue if GPs were left to fight it out on PCG boards. Indeed, in setting PCG chairs' remuneration at the levels he has, Mr Milburn has also rightly underlined the limited role he expects GPs to play in day-to-day management.
As PCGs evolve into primary care trusts, however, chief executives will naturally expect their salaries to grow to reflect the additional level and complexity of responsibilities, and presumably some thought will already have gone into ensuring that pay levels also match those in existing trusts. Mr Milburn must resist the temptation to use this process as a means of pushing down management costs by restricting salaries in primary and community service management. There will also be a need to ensure that the reward structure meshes with any new pay system encompassing the NHS as a whole. For the first time, there is now an opportunity to bring salaries within primary care management into some sort of sensible relationship with those in the hospital sector, and this should apply as much to those in less senior or more specialist management posts as it does to chief executives.
In the meantime, there is much work to be done - as NHS finance director Colin Reeves' health service circular on funding arrangements for the new system makes all too clear (see News, page 4). The 9.1m announced by Mr Milburn at last week's primary care conference to get staff in place now will make little impact on the task, however. As one commissioning manager pointed out after the minister sat down, it amounts to just 20,000 for each PCG - and even added to the 22m start-up cash already allocated gives a frighteningly small resource for such a major change.
Compare that to the experience of the Conservative reforms when money appeared to be no object. And though health authority costs will inevitably decline as PCGs take on many of their duties, it remains to be seen how running 500 separate commissioning bodies will prove less expensive overall than running 100 HAs. Ministers are rapidly discovering that the process of reform itself is enormously costly - big bang reform even more so.