A mixture of excitement and apprehension was evident at the National Association of Primary Care conference, as around 130 new primary care trusts prepare to go live.Lynn Eaton reports

The National Association of Primary Care is riding on the crest of a wave: so much so that its chair, Dr Peter Smith, felt confident enough to recite a Laurie Lee poem on the joys of spring to open last week's London conference on the future of primary care.

There certainly are a few joys of spring around at the moment for the association. Once out in the cold, Dr Smith quietly admitted to HSJ: 'Yes, we do feel we have the ear of government at the moment, ' but refused to comment on whether that was at the expense of long-term rival, the NHS Alliance.

Dr Smith welcomes Downing Street's decision to distribute incentive money of£10,000 per practice to primary care - something he has been campaigning for personally for months. But he is not unrealistic about the task ahead for the new primary care trusts.

About 130 came on stream on 1 April against a backdrop of increasingly centralised control, an uncertain financial future, and often devoid of the information on costs and workload that fundholding practices once held dear.

So it was a somewhat jaded and cynical audience that heard of the opportunities and challenges ahead. The conference chair, BBC health correspondent Richard Hannaford, suggested primary care staff might see themselves judged in future on how well they prevented illness, not just how well they treated it.

Traffic lights, already used in hospital trusts to determine how much freedom they have to spend money, were 'clearly something that is going to happen' in primary care, too.

Dr Jennifer Dixon, director of healthcare policy at the King's Fund, highlighted the current inequalities in primary healthcare provision.

Studies have shown that people from poorer, working-class or ethnic-minority backgrounds are less likely to be screened for cancers, less able to get a GP appointment when they want it, and are likely to wait longer to be treated for heart disease, she said.

She called for closer monitoring of the way GPs are distributed around the country, something which will no longer be carried out when the medical practices committee is abolished.

And she agreed with concerns raised by the audience that too much of the new money for the NHS was centrally allocated. 'This means less money available for local initiatives, ' she said. 'I agree this is cramping innovation, but That is politics, I am afraid.'

Nonetheless, PCTs still have a lot ofinnovating ahead of them, not least in meeting the intermediate care agenda. Professor Sir Cyril Chantler, senior associate with the King's Fund, spelt out the different forms this might take - from beds in nursing homes through to an integrated intermediate healthcare centre, with 24-hour phone advice linked to patient records.

But Mike Parsons, chief executive of Barchester Healthcare and Nursing Home Association, had a different tale to tell - of health authorities not even prepared to talk to the private sector, despite guidance from the Department of Health that they should. That was something he hoped PCTs would not replicate.

'GPs have to understand the concept [of intermediate care]. In my experience, this is quite patchy, ' he said. 'Some GPs are very up-to-speed with the idea - some are not at all.'

Working with social services could also be beneficial, suggested Trevor Boyd, assistant director for elderly and physical disability adult care services with Hertfordshire social services.

His authority had set up 11.5 social worker posts linked directly to GP practices. They were able to provide care packages within four hours of being notified by GPs.

'To January 2001 that cost us£163,000. If those people had been placed in hospital, the estimated cost to the NHS, at£350 a day, would have been£1.4m.'

Another day, another czar

Dr David Colin-Thome will take up the newly created post of national director for primary care services in May, leaving his role as director of primary care for London region.

He has been a GP for 30 years - the last seven of which have been part-time - while holding a series of other positions.

Dr Colin-Thome has also worked at North West regional office as a primary care adviser and was a senior medical officer for the Scottish Office.

At an introductory briefing at the Department of Health, he said the difference between the new post and that of director of primary care - a post taken by Kathy Doran in March - is that Ms Doran's role is an operational one, while his new post will be 'more about ideas and models'of different ways of working and organising primary care.

Asked if there is a need for 10,000 more GPs, as the British Medical Association has suggested, Dr Colin-Thome said: 'I think we need more GPs, but whether it is as much as 10,000 is another matter - 10,000 is what would be needed if all the work was to be done by GPs.My argument is we need to use nurse practitioners.'

Dr Colin-Thome welcomed the recent announcements of incentive schemes for GP practices as 'crucial'for them delivering the NHS plan, and argues that more work needs to be done on analysing how GPs use their time and resources.