‘I don’t want to see the PCT re-created for me to be then told what services I can have as opposed to the services I need for my patients.’ So said a GP commissioner I saw recently to discuss the merger of community health services with his local acute hospital trust.   For me this quote summarises in a sentence why strengthening GP commissioning is such a compelling argument. Some will think this is an overly simplistic view of the world but why not? We spend years creating organisational complexity and then seem to expend equal effort trying to simplify it.

On the same issue, another GP commissioner said to me, ‘I want to make service delivery decisions where cost-effectiveness is considered alongside other criteria but not where it’s the main driver.’ Okay, it’s something of a tall order in the austere years ahead (requiring more sophisticated management above all else) but it’s another compelling argument that’s hard to disagree with.

Notwithstanding these views I’ve said previously that for me there are two principal tests for GP commissioners - can they look beyond their local community to develop a strategic overview and will they be allowed to make the difficult reconfiguration decisions?  

When I’ve looked at these issues through my work what at else stands out is the desire of local authorities to have a close strategic relationship with an NHS body, such as a foundation trust, that’s likely to be around for a few years. Not a bad basis for starting a relationship and with hindsight an issue that’s bedevilled the NHS development of strategic partnerships.  

I’ve also been encouraged by the chief executive of an acute foundation trust talking of the significant impact the merger of community health services will have on his organisation. Clinical service pathways, consultant-GP relationships, board working, senior managerial development and organisational culture will all have to change. In short, it’s not a bolt-on but a major transformational task.

So, am I convinced of the coalition’s health policy? Yes, but whilst I support the envisaged end game I’m under no illusion that the transition will more challenging than any of the innumerable reorganisations I experienced during my time in the NHS.