The NAPC annual conference was a politically subdued affair this year. Everybody happy, then - or just too busy getting on with the job? Paul Stephenson reports

So what was it that made this year's annual conference of the National Association of Primary Care such a quiet affair?

Perhaps the worst storms for 13 years put everything in perspective. Or perhaps the thought of health secretary Alan Milburn (subsequently replaced by health minister John Denham) arriving in Harrogate on Hallowe'en was just too spooky a coincidence.

Then again, perhaps it was just that the majority of delegates are so tied up in learning to manage and organise the new NHS that they have stopped worrying about the bigger political issues, and are getting on with the job.

Despite concerns from GPs and others about the pace of change and new arrangements for out-of-hours cover, Mr Denham's announcement that quality standards would be put in place for all out-of-hours services was greeted without a murmur.

And Mr Denham was gentle on those GPs who were anxious they would be pushed too fast into the national roll-out of NHS Direct.

'The pace of change locally will need to reflect local needs, ' he insisted.

He told delegates that over 1,000 firm proposals had been put forward for practices to join personal medical services, with more expected by the end of the year.

This would mean that the number of practices under PMS should treble by next October.

Mr Denham suggested PMS had been subject to 'a number of inaccurate representations'. Concern about pension rights, for example, was unjustified. He told delegates: 'We envisage that there will be consistency of pension arrangements as far as possible between PMS and general medical services.'

The organisers were pleased to announce that Mr Denham would take questions after his speech, but the delegates were not really interested in having a go. No wonder he was smiling broadly at the press briefing that followed.

What really got the delegates warmed up, however, was a roleplaying session by members of Fenland primary care trust in which they explored the way a PCT chair, chief executive and executive committee chair can work together to run an effective body (see box overleaf ).

At the point the session ended, the PCT's drug budget overspend had not been resolved. And it was clear that worried delegates wanted to see what would happen.

The tone for the conference had been set by NAPC president Dr Rod Smith, who had made it clear that despite problems such as staffing, the organisation was committed to working with government to get things done.

Describing it as 'one of the most important conferences we have run', Dr Smith said that although more nurses and doctors were welcome, 'one of the key challenges is retaining nurses and doctors who are already there'.

Flexible working was central to helping with this.

Although NAPC chair Dr Peter Smith said the message they were constantly getting was that there was a 'demoralised, alienated workforce' out there, it was clear that most of those at the conference wanted to get on with things.

NAPC president Dr Rod Smith told HSJ: 'I think the mood of people here is very quiet.

However, behind them are hundreds of nurses and GPs who are uncertain.

'We are waiting patiently. There is a feeling that the national plan is good. The vision is right.'

A call for more positive action from GPs and the primary care sector came from US professor of comparative healthcare studies Donald Light. While professing himself to be a great admirer of the NHS plan, Professor Light outlined what he thought needed doing to ensure effective commissioning.

He said: 'You need stronger leaders. There is a tendency to wait for what the government is going to come up with next.

'What is it you are for? You need better management skills. You are driving into new territory and it is not something you have been trained for.'

Professor Alan Maynard put the usual cat among the pigeons by asking the delegates to question the assumptions politicians had given them to work with - for example, that there was an optimum size for PCTs.

The importance of closely involving primary care in the running of the various new regulatory bodies was emphasised.

Andrew Dillon, chief executive of the National Institute for Clinical Excellence, said that it was important to involve primary care in drawing up guidance, and that there would be more involvement in future by outside bodies and the various colleges and national organisations.

Mr Dillon said that at the moment topics for consideration by NICE are selected by the Department of Health and the Assembly for Wales, but that in future this should change: 'We are hopeful that, over time, the way topics are selected is made more appropriate.

'It is important that the NHS has a chance to influence the list.

'The national organisations should be able to say [with regard Continued from page 13 to existing treatments]: 'this is a real problem, what can you do about it?'' Although NICE has a clear brief to produce guidance, Mr Dillon told the conference: 'We don't know what NICE's responsibility is to be for implementation.'

Mr Dillon told HSJ that it would be impossible for NICE to monitor implementation of its guidance unless it had a staff of about 500, compared to its current 30. But he said there were various things that it could be involved in and was considering. 'We have got to create links with regional offices and the national teams. We can maybe form alliances with them.'

Mr Dillon was clear, however, that the guidance was being welcomed and acted on. 'There is a lot of support for NICE. Chief executives say it is a personal responsibility.'

It was clear that most participants expect next year's conference to be more exciting because there will be real results to discuss. As Kingston GP Dr Phil Moore said:

'Nobody has enthused about what benefits there are for patients.

'Next year I am looking forward to seeing the results.'

So, what about the future of the NAPC and a possible link with the NHS Alliance? There was no mention of it from the platform, although delegates who spoke to HSJ all seemed to agree that the logic of PCTs meant there ought to be only one representative body.

Dr Rod Smith said that although the two organisations had 'been co-existing', a future single body representing PCTs 'would seem to be the logical development'.