primary care groups; Personal gain and influence have always been the most significant factors driving change in general practice. So, asks Ray Wilcox, how will chief officers in primary care groups cope?

The race is well and truly on to set up 500 small organisations, appoint 500 chairs and 500 chief officers and be set to go by 1 April.

But what sort of job will the post of chief officer be? What sort of future lies ahead? What sort of skills and knowledge are right for this role?

The most worrying thing about primary care groups is whether GPs are committed to their future. At the moment, the signs are not good. Rather too many are still trying to decide whether it is the right game to be in.

Motivation has been the only significant factor to have driven change in general practice since the beginning of the NHS - personal and group motivation. GPs' contractual relationship allows them the luxury to ask: 'What's in it for me?'

This is not intended as a criticism, merely a factual observation. And the difference between GPs and people in any other organisation going through change is that GPs have the option - or the luxury - to ask why, and then decide whether they agree.

The introduction of PCGs is not the first proposed change in primary care to have involved GPs, but there have not been many. The 1996 charter was the first significant change to general practice since the beginning of the NHS. But that change was largely to the remuneration structure; it was a positive change for GPs and they embraced it willingly.

But, overall, general practice did not change in the way it was organised, structured or delivered. The partnership model, the non-specific contract, the wide variation in quality all continued as before.

Despite government pronouncements throughout the 1980s and early 1990s about the need to change general practice, to bring all practices up to the level of the best, nothing much actually changed.

The imposed 1990 contract forced the question, 'What's in it for me?' The question was easy and the answer, for the majority, was simple. Nothing.

And so in large measure the profession rejected it, leaving individual family health services authorities to battle to implement a contract the profession had rejected out of hand. No motivation factor here - and some lessons for PCGs.

Fundholding was different. Fundholding had motivators for change built in: influence, power, control, money for the practice, additional interest for many GPs frustrated with a long career without much variety. After initial hesitation, GPs took up the challenge in droves.

Not that everyone believed in it, of course, but there was a strong motivation to take part. And it did not matter if you chose not to because it was optional. Not everyone shared the motivation and many retained, as they saw it, the moral high ground.

Within the profession, between fundholding and non-fundholding GPs, there has built up a feeling of them and us - those who took the shilling and those who rejected it. And those who rejected it have seen their equity investment in their practices remain lower - sometimes much lower - than that of fundholders. Many GPs have long memories.

GPs abhor everything bureaucratic, and health authorities delight in everything bureaucratic because that's where all decisions about purchasing (sorry, planning) and resource allocation are made. HAs' ways of working at an organisational - not a personal - level are anathema to most GPs.

In what image will PCGs be built? In the image of the practice, of the HA or local authority, or a mixture?

If, as widely expected, the majority of chief officer posts go to HA people (as opposed to practice manager people), the scene looks set for an interesting period of development, as PCGs look for their own image. Against this background, step forward some 500 rather uncertain GPs as potential chairs, anxious about what exposure to taking rationing decisions will mean, and often with anxious partners wondering what having a partner as chair of a PCG might mean for them.

And into this arena will also come 500 chief officers armed with a lot of enthusiasm but meeting a very mixed collection of people to make up their 'team'. They would find it useful to talk to practice managers about managing general practice. It is very different to managing in a hierarchy.

The lot of the health service manager is not always a happy one: subject to constant 'redisorganisation' and now on the verge of being asked to forgo the relative stability of the mother ship for the insecurity of the smaller satellite.

In seminars and workshops, the question about PCGs - and GPs within them - is still the same. Where is the motivation? Not motivated? Won't play.

Will PCGs work? Of course, because they will not be allowed to fail. But PCG chief officers will need something other than the usual managerial skills and knowledge. They need to come with a pocketful of motivation.