GPs must recruit high-paid, high-powered chief executives to run primary care groups or watch them founder, a top health policy analyst warned last week.
Professor Nick Bosanquet also told fundholders' leaders they should 'encourage early retirement' among GPs who wanted to go. The next wave of reform would be 'a job for the young at heart, and perhaps for the young in calendar years as well'.
Speaking at a National Association of Fundholding Practices conference, Professor Bosanquet warned: 'Unless there is a general management core to PCGs they will very soon run into a lot of problems.
'You need a highly qualified manager. It is no good just saying to the fundholding manager, 'we are upgrading you'. It is quite a different role.' Managing a PCG would mean dealing 'on equal terms' with clinicians, managers and the press.
'You need to get one good manager, and basically he or she has got to be paid pounds50,000-plus - probably a bit more in some parts of the country. It has to be a chief executive-level person because it is a big job.'
Professor Bosanquet, who has studied the development of fundholding first at York University and subsequently at Imperial College, London, since its inception, went on: 'I would urge you to encourage early retirement where people want to do it.
'This is going to be a job, on the whole, for the young at heart, and probably the young in calendar years as well. You need people in their late 30s and early 40s who really want to push this forward.'
Speaking at the same conference, Laurie McMahon, director of the Office for Public Management, predicted that doctors entering general practice in the wake of the reforms would come to see practice partnerships as 'increasingly anachronistic'.
He said that as giant 'metro hospitals' covering populations of up to 2 million would take specialist work away from district general hospitals, so the development of GP hospitals would contribute to their demise by taking away less intensive cases.
Such hospitals would bring groups of 40-50 GPs together to cover populations of up to 100,000.
'These will be heavily managed institutions with very powerful management,' said Mr McMahon. 'They have to be because of the complexity of the things they are doing.'
See News Focus, page 15.