conference focus

Would managing primary care groups be easier if GPs lost their independent contractor status? Yes, said GP and Newcastle West PCG chair Dr Debbie Freake. No, said North and East Devon health authority chief executive Dr Gill Morgan.

'It's quite difficult sometimes for independent contractors to support the best interests of their small business and of the community. They're not always necessarily the same thing,' said Dr Freake, herself a salaried GP. She said it would be helpful if GPs were salaried - although she conceded this was not crucial.

Dr Freake had been surprised by the number of GPs she knew who had expressed interest in salaried status. 'But issues of negative equity have a lot to do with that.'

Dr Morgan thought it was important not to lose diversity. 'I don't see independence as a handicap, but for those who don't want it we need a range of options to let them link into the system.'

She confessed to anxieties about PCGs' managerial capacity, local 'political' expectations, the 10-year timescale which the NHS seemed to be trying to achieve in a year, and talk of independent fiefdoms.

But as an HA chief executive she felt 'comfortable' with PCGs, and was looking forward to devolving many tasks to them. In return, the HA offered resources, a framework for action and support with organisational and personal development.

Dr Freake said PCG chief executives needed an in-depth knowledge of commissioning, an ability to work in detail with practices, political weight and a willingness to take risks.

West Dorset Central PCG chief executive Carole Lawrence-Parr said PCGs' greatest need was to overcome resistance to change. 'To do this we need to communicate, communicate, communicate,' she said.