One of the few groups of NHS professionals who the current health secretary has been able to rely on for support are the GP leaders of pathfinder commissioning consortia.
At times, Andrew Lansley has made the political mistake of over-claiming for this group. He is not right, for example, to say that the GPs working with consortia covering 90 per cent of England support him, because there is often a gap between the enthusiastic leaders and the more sceptical followers.
But Mr Lansley is right to point out that the main source of energy for change will come from these GP pathfinder leaders. And it is this group of enthusiasts that will now be tested as the government rethinks its policy.
From the start of this financial year, most pathfinder GP commissioning organisations are losing the PCTs that they have been working with.
Some familiar faces will have moved to the new PCT clusters; others will have disappeared. What this means for GPs committed to their locality is that the NHS organisations meant to help develop them have now become more centralised and less localised.
What is more, the SHAs and the clusters are dominated by the need to implement their Quality, Innovation, Productivity and Prevention (QIPP) programmes. SHA and cluster QIPP leads have a certain amount of QIPP savings to generate in every activity and in every locality. For only some of these is there recognition that what is important is saving real money. For others what will matter will be getting their QIPP savings boxes filled in.
GP commissioning leads will have to insist that the resources where they can make savings are real ones, from which spending can be cut within this year, and not the fictitious savings programmes of the past.
This will involve them in some conflict. We are already one month into 2011/12 and, for savings to be real, GP leads need to move beyond grand plans to immediate actions.
Also, GPs who volunteered for pathfinder projects did so to run their own GP commissioning consortia. It looks now as if parliament will insist a range of other people go on the boards of, not GP consortia, but 'NHS commissioning authorities'. GPs will almost certainly be in a majority, but it will not be left up to GPs alone.
All of this will test GPs' enthusiasm. Some may feel that being enmeshed in a bureaucratic set of relationships is not what they signed up for. It will certainly feel different from how it was meant to feel.
However, if GPs can still think that they have a right to demand their own way of making real savings and develop their own commissioning intentions, they will be able to continue channelling their enthusiasm to some effect.
As with most things in the NHS, the new will only achieve more success than the old if GPs are prepared for conflict.
- Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at www.pauldcorrigan.com