Commissioning 'key' but so is practice support

So what did we learn at last week's BMA special representative meeting (SRM)? It may have backed scrapping the Health Bill but it did not oppose commissioning, which is arguably its big idea.

The BMA's policy of 'critical engagement' with the Bill had not failed and all-out opposition to reform was lost. BMA chairman Dr Hamish Meldrum lives to negotiate another day and even health secretary Andrew Lansley was spared the embarrassment of a 'no confidence' vote.

The possibility of industrial action seemed to disappear quicker than the dessert at lunch at The Grand Connaught Rooms in central London.

For more colour and the results from the SRM visit

This week's GP reveals an in-depth examination of the results of the King's Fund's inquiry into general practice. Verdict: good - but could do better. And what an endorsement of commissioning it appears to be. It points to the need for improvements including 'a significant proportion of referrals made in general practice may not be clinically necessary', highlights variation in care and describes the 'key role' of commissioning in driving up standards.

Key sentences include: 'Significant potential exists for reducing the number of emergency hospital admissions for conditions that could have been managed in primary care', and; 'Practices need to be supported in creating an environment within which quality improvement can flourish'.

The inquiry also recommends the GP role changing from gatekeeper to navigator or 'expert adviser'. What is important in any debate about improving variation in healthcare is that the emphasis is on support for practices perceived to be doing less well.

The report recognises the need for better data to take into account case mix but also the greater potential for partnership working that both consortia and federations offer. What is important is that consortia use 'the levers to drive improvements and challenge poor practice' in a way that is supportive of those practices they are working with.

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