The NHS risks 'pinning too much' on the financial gains of demand management, a leading voice in primary care has warned.

The NHS risks 'pinning too much' on the financial gains of demand management, a leading voice in primary care has warned.

Dr Barbara Hakin, who becomes chief executive of East Midlands strategic health authority next week, made the warning in an interview with HSJ.

Asked about the role of demand management, the former NHS acting director of commissioning said: 'I'm hugely experienced in commissioning and in changing the clinical pathway. And that experience does give me some cynicism. This is not the absolute panacea for the ills of the NHS. By doing these things you can find unmet need, you can change the way you do things just because you can ? and not necessarily find it's cheaper and better.

'I'm really nervous about how much is being pinned on managing demand because it takes a very long time to change clinical practice: there are lots of GPs who just want to work and see patients.'

Dr Hakin stressed that developing demand management policies was 'really important', but said she was concerned by some of the 'ambitious figures' being bandied about.

She also said her own experience in the early days of primary care trusts gave her some concern about whether enough attention would be paid to corporate assurance and governance as practice-based commissioning is introduced.

'In the early PCT days, because of my clinical background, I made the mistake of not being careful enough about governance and corporate assurance, and it was fine because there was a strong team of highly committed and professional people who worked out that they not only needed to know they were doing the right thing, but also to demonstrate it.'

'One thing that concerns me about lifting the lid on practice-based commissioning is that GPs are not corporate creatures, and there are dangers about changes being made to the way services are being delivered which are not properly assured, and without proper scrutiny of value for money or patient safety.'

Dr Hakin said that looking back to 'the early days' leading Bradford South and West PCT, she could think of 'instances where some invasive treatments might have been carried out in primary care, when the patient safety aspects may not be properly scrutinised.'