This is one of the areas where the process of establishing primary care groups has been amicable.

The health authority set up a white paper development group involving local GPs, the local medical committee, trusts and other stakeholders to 'take forward all issues, making sure everyone is involved'.

Proposals have already emerged for three PCGs centred on the larger towns in rural areas. But there is less consensus about what should happen in Plymouth, a city of 240,000 people.

'Even in Plymouth things have been going relatively smoothly,' says Charlie Daniels, chair of South and West Devon local medical committee.

'It is just a question of deciding what we want or need. Most GPs are looking at one PCG. Other staff are looking at smaller organisations.'

Dr Daniels says: 'The relationship between the HA and its GPs is very good. That has been the real key to success.

'Also, there has been no problem remunerating GPs for attending meetings and putting time into the process.'

He points to the 'large number' of fundholders in the area as a force for change.

'They can see the (fundholding) scheme is ending and they want another system in place to try to retain the benefits,' he says.

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