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Published: 24/10/2002, Volume II2, No. 5828 Page 24

The NHS Alliance's conference had everything: a sense of optimism, a provocative turn from Nigel Crisp - and a nice story about red squirrels.Paul Stephenson was there The message which continues to be driven home by the government is that the future of the NHS is in the hands of primary care. Judging from the enthusiasm of those attending the NHS Alliance's annual conference in Harrogate last week, it looks as if it will be well looked after.

Yet the faith of policy-makers in those managing primary care is somewhat more ambivalent, according to one source HSJ spoke to. Some officials and ministers in the Department of Health and officials in Downing Street are understood to remain unconvinced that primary care trusts are capable of delivering on their agenda.

But many PCT managers at the conference seemed keen to embrace the challenges ahead.

They said they wanted to get on with the task in hand, and their concerns were about reconfiguring services and how to get more resources. Some delegates even said they were pleased with health secretary Alan Milburn's honesty when answering difficult questions about the limited resources they are currently working with - even if the answers were not what they wanted to hear.

Mr Milburn was questioned about the pressure on PCTs from prescribing budgets, and he made it clear they had to manage with what they had: 'There is huge pressure on prescribing. This is the number one issue, but there ain't any more money. You are not getting any more money. The issue is how you make the money work.'

Alliance chair Dr Michael Dixon told HSJ there is now real optimism that solid progress will be made over the coming year, both by PCTs and by clinical staff in getting back into the driving seat of those PCTs.

He said this was in marked contrast to the past year, in which little seemed to have changed. The issue is about making a mark in the next few months.

Dr Dixon told the conference:

'Delivering a new, modern NHS depends on the three-year plans we are making over the next six months. And that - let's face it - will be the make or break of PCTs, and the make or break of the NHS. The next six months are going to be the most crucial of our lives.'

Crucial to this were relationships with strategic health authorities, and delegates made it clear that there is no love lost between PCTs and many SHA chief executives. Dr Dixon even told the conference: 'I must warn you, there are a few who want to block our progress.'

NHS chief executive Nigel Crisp told the conference that PCTs had to be realistic about their demands, in particular around extra staff, and redesigning services was just as crucial: 'I was with a PCT who said, 'We need 280 more GPs'. My challenge back to them was: be realistic. Are you going to get 280 GPs?'

This was not music to delegates' ears. Mr Crisp later expanded on the theme: 'I deliberately said that rather provocatively. The solution will vary from place to place.

What other ways are there of addressing the problem?

We are not going to reach the number of GPs we need on an old-fashioned basis.'

The message about GP numbers was pressed home by several speakers, including Mr Milburn, throughout the conference.

Mr Crisp's message was that services needed to be redesigned, and linking up with areas outside of health is crucial - particularly education. 'It is about being behind the bike shed, ' he told the delegates, adding 'perhaps that is not a good slogan'.

Royal College of GPs chair Professor David Haslam highlighted the problems of recruitment, and particularly retention, when he talked about the problem of low morale and GPs wanting to leave the profession: 'They say, 'I can't take any more change' and they go and change professions.

They can take on the most fantastic change [of profession] because it is driven by themselves.'

It is not always problems with resources and service reconfigurations, however, that put PCTs in the headlines. South Birmingham PCT chief executive Cynthia Bower told the conference it was condoms and red squirrels that had been key issues for the local media.

The first was in relation to work on sexual health the PCT had been involved in, and the second to the Royal Orthopaedic Hospital trust.

She said: 'We have a very small, stand-alone orthopaedic hospital.

Every time somebody talked about closing the hospital, it was pointed out the hospital was home to a group of red squirrels.

These squirrels have had their impact on the NHS locally.'

Whatever the issues they have to deal with, the clear message from the conference was that this is make or break time. The next few months will start to determine whether the doubters at the highest levels of government are going to be proved wrong .