conference focus :

At the end of a speech in which he went out of his way to talk up the importance of the public service ethos, Alan Milburn stunned delegates by announcing his intention to hand negotiations of the GP contract over to the NHS Confederation.Tash Shifrin reports The government will hand over negotiations on the GP contract to the NHS Confederation, health secretary Alan Milburn announced in his speech on the last day of the conference.

'The process of negotiation will be helped if the NHS rather than a government department or government ministers speaks for the employers' side of the table, ' he said.

'GPs - whether they are independent contractors or salaried employees - work for the NHS. It must be right for the NHS to speak for itself as the negotiations begin.'

The NHS Confederation would need to consult on the plan he added.

The surprise announcement came at the end of a speech in which Mr Milburn stressed the importance of 'the public service ethos' to the NHS and re-emphasised that 'reform in the NHS has to come from within the NHS', playing down the role of the private sector. 'We risk the ethos of the NHS, its values and principles at our peril. That is why we say while we will forge a new relationship with the private sector, it is just that: a relationship, not a takeover. NHS values are not the same as private-sector values.'

But he added that because 'we do need every bit of help we can get', the government would 'not close our minds to the NHS and the private sector co-operating where private-sector expertise or finance can benefit NHS patients'.

And Mr Milburn echoed recent statements from Downing Street following trade union attacks on public-private partnerships.

'We will work - I will work - with all of those who genuinely want to make reform happen. But I say to those who would stand in the way of reform: there must be, there can be, there will be no veto on reform, any more than there can be a veto on the pace of reform.'

Mr Milburn also restated the government's second-term emphasis on 'delivery' and announced he was allocating£75m to take forward reforms in orthopaedic, dermatology and ear, nose and throat services.

And he said that 'within two years', primary care trusts would receive direct cash allocations, while both PCTs and trusts would receive block capital funds directly in future as well.

The reaction among delegates was mainly positive. Gill Morgan, chief executive of North and East Devon health authority and a former president of the Institute of Health Services Management, said Mr Milburn was 'absolutely fantastic, focused and with no ambiguity'.

She described the change to GP negotiations as a move that was 'absolutely first-rate and took a lot of courage' and showed the government was genuine about decentralisation.

David Panter, chief executive of Hillingdon PCT, also welcomed the NHS Confederation involvement in GP contracts. 'It is a skilful sideways step, but it is good news. GPs in my own area want flexibility in their contracts, and at least with the NHS Confederation involvement we are bringing genuine experience of the health service into the negotiating room. Obviously PCTs couldn't get involved, or the health authorities, because they can be seen to have vested interests. This way things can move more smoothly.'

In his official response to the news that the NHS Confederation would take on responsibility for GP negotiations, chief executive Stephen Thornton said: 'We can see the potential benefit of putting in the driving seat of negotiations on the employer side those who actually manage primary healthcare on the ground. This could well be a radical step to overcome the current delays in the negotiations.'

The British Medical Association welcomed the announcement.

But GP committee chair Dr John Chisholm warned Mr Milburn that he retained ultimate responsibility for funding and creating the right conditions within the health service.

'If Mr Milburn's move is a recognition of the urgent need to press ahead with negotiations on a new contract, then involving the NHS Confederation which has frontline experience of managing primary care, could be a constructive way forward, ' he said.

'The secretary of state may be choosing to delegate the conduct of negotiations, but clearly, he cannot delegate his responsibility for the funding of the service and for creating the conditions which enable doctors to deliver a high-quality service to patients.'