Friendly society Does NAFP chair Rhidian Morris's exaltation to fundholders to 'start making these reforms work for you' herald a change of heart towards Labour policy? Mark Crail reports

Speaking at a conference which he said 'closed the book' on fundholding, he told an audience of 500 GPs and primary care managers: 'Don't leave this room and do nothing. Think, please, think about what you can do.'

Dr Morris said that, as chair of the National Association of Fundholding Practices, he wanted to see it join bodies representing commissioning GPs and multifunds to create 'a new organisation'.

And it would change its name in time for its annual conference in November to something 'not too closely associated with any particular system'.

Since the publication of The New NHS white paper, some people had suggested that primary care groups would replace practices as the basic unit of organisation, and others that it would spell the end of GPs' independent contractor status.

'It was because of this that NAFP recently saw health minister Alan Milburn and asked him to clarify the situation,' said Dr Morris. 'To me the reply was clear and unequivocal.

'Mr Milburn intends to give GPs power, genuine power, in return for accountability. That does not sound like a salaried service or even a controlled service. It means what it says. We must be transparently accountable for the actions we take.'

But he warned that membership of a PCG would be demanding. 'Anyone who thinks being at level 1 is an easy ride had better think again. Indeed, I fail to see how you can discharge all the other functions of a PCG without accepting commissioning, so you quickly need to go to level 2. Once there, you are likely to desire to become independent of the health authority and move to level 3.'

Level 4 was 'more complex' and might involve a number of solutions, he said. 'The arrow (in the white paper diagram) is there for a purpose. PCGs will progress up the stairway.'

Taking issue with the idea that all GPs in a PCG could manage it effectively by way of monthly meetings, he advocated a smaller group which would be accountable to the wider body of primary care staff 'and can be sacked at its meetings'.

'I am sure that many models will be created. So start creating them. Don't sit back and let someone else do it. Start making these reforms work for you.'

He said PCGs should 'not be fooled' by the pounds3 per head management allocation. HAs should retain only enough money to cover core costs and devolve the rest to PCGs, 'so that management budgets could be between pounds5.80 and pounds7.20 a head'.

If HAs complained the public health agenda meant they needed to retain more, the solution was to merge HAs. PCGs should be able to buy management skills from HAs for two years 'to provide stability' but should then be free to go elsewhere.

'I have always been a great supporter of HAs, but once PCGs are up and running, I cannot see a need for more than 50, and it could be as low as 30,' he said. 'I regret this, but I did not write the white paper. It exists and we must react to it.'

See Comment, page 19.