A year after the birth of the NHS Primary Care Group Alliance, Kaye McIntosh detects signs that former rivalries are abating
The relationship between imitation and flattery is well known. New Labour adopted the policies of the group formerly known as the National Association of Commissioning GPs, ended fundholding and created primary care groups.
In return, NACGP had its own Blairite revolution and created the NHS Primary Care Group Alliance.
Rumours of a merger with the rival National Association of Primary Care, born out of the fundholding movement, were played down.
Fundholders had lost the political argument. With the end of the Conservative era, commissioners were the future and the alliance was ready to lead them forward. A year on, the alliance has a few developments to report.
At its spring conference last week, chief officer Michael Sobanja announced that the Royal College of Nursing had joined the list of member bodies, following the precedent set by the Community Practitioners' and Health Visitors' Association.
And it has elected its first president. Dr Andrew Willis, who stood down as chair of NACGP last year, was unanimously returned as 'elder statesman', as Mr Sobanja described it.
But it was obvious that nurses were not the only targets for partnership. A cautious courtship with former fundholders is back on the agenda.
NAPC executive committee member Dr Peter Smith had been invited to speak to the conference on how PCGs could learn from the experience of multifunds.
It is not the first time the alliance has invited a multifund representative to speak.
And alliance membership and executive positions have always been open to all fundholders, whether individual or community.
But Dr Smith also happens to be a member of a liaison committee between the two organisations.
Alliance chair Dr Michael Dixon says the liaison group is 'looking into common messages and how we can work together in the future'.
A merger 'could happen, but the philosophies are still different'.
Dr Smith says the committee has 'never actually talked about a merger'. But 'there will come a point in future when it is difficult to see why the two groups differ'.
Dr Smith admits there have been 'discussions about joint membership' but says everyone has been 'too busy' setting up PCGs to take the idea further.
Alliance president Dr Willis is at pains to point out that the alliance and its predecessor had never been 'anti-fundholding'.
The whole 'division' between fundholders and non-fundholders 'although real at the time', was 'a load of nonsense', he says.
Alliance members seem resigned to eventual merger. One says it is 'inevitable', although not necessarily popular.
Dr Chris Francis, vice-chair of Norwich PCG, says there is no urgency 'unless the government wants to attack primary care as a whole'.
Most members would not be concerned by a merger, but he says some would leave because of the 'fundamental political differences and a lot of history'.
Both organisations agree that some hard work will have to be done before they are ready to align.
Dr Smith says the NAPC is convinced there is still 'a political agenda which is achievable' for its own members, such as practice-based incentives for taking part in PCGs.
'While the policy is being written there is the possibility of differences in emphasis,' he politely observes.
Dr Dixon agrees: 'There is a big commitment to practice-based commissioning in the NAPC at the moment and pressure for incentives at practice level for playing a part in PCGs. They are still in the grieving stages for fundholding.'
Memories of the bitter differences of the past may be dimming, but they have not faded completely.
Dr Willis says: 'The great majority of GPs did not want to be fundholders. The over-50 per cent figure was widely trumpeted, but the government didn't get there until shortly before the election.'
And he is still resentful of the NAPC's resources: his organisation has led 'a hand to mouth existence', he says.
'The alliance has never taken any taxpayers' money.
'All our members have paid their own way while NAFP was paid for by the practice fundholding budget and was able to put on swish conferences.'
There is appreciation for the alliance's work from the government. Health minister Baroness Hayman told the conference she would like to 'thank this organisation for its support over the years'.
But Dr Dixon says it is strange that the 'organisation that has been most committed to government policy is the one that has never been able to get funding centrally'.