I am not convinced that practice-based commissioning (PBC) can be justly compared with the biggest football match of the year, what with the world cup around the corner ('Is any one playing the PBC game', GP, 19 May).
Even as a Stoke City supporter, I would take exception to that.
There are a lot of single handed practices. They like the freedom of being relatively independent; for them it is a threat.
PBC is currently an England-only initiative. However my guess is that it will have UK-wide implications . The NHS is going through yet more radical changes.
The government wants to create an internal NHS market. There is much written about larger GP units, with super practices and core groupings.
This ignores historic experience - practice disagreements have caused many large practices to split in the past.
The BMA is aware that PBC might not hold sufficient appeal to GPs. There are concerns about overstretched GP capacity. The recently published technical guidance has also introduced a number of disincentives to the scheme.
However, there are many reasons why practices should consider becoming commissioners.
Alternative providers of medical services (APMS) are a growing reality and a threat to conventional general practice. So far their performance has left much to be desired, but that could change.
The political imperative for PCTs to develop APMS could result in patients being diverted to private-sector primary care providers. Beware national organisations with vast financial resources that can operate at a loss for considerable periods.
So, if a practice becomes a successful commissioner, it will have more control over the forces that otherwise would affect their working environments.
As was argued in the early days of fundholding, if GPs decide not to hold budgets, others such as district nurses, community matrons or private providers will jump at the chance.
PBC has the ability to develop conventional NHS general practice. Service redesign via effective commissioning will move resources into primary care using freed-up funding for the development of in-house services.
This would create a robust multi-faceted primary care sector. Community services and personal longitudinal care provided by GPs have demonstrable benefits to patients.
Much detail is still lacking on the initiative, perhaps intentionally.
As a result it will be down to LMCs and practices to fill the gaps via local negotiations with PCTs. This will encourage innovation. 'Best practice' will develop, for others to learn from. The DoH has developed a support programme for the practices and PCTs.
In 2006, Payment by Results will cover elective inpatient and day-case care, except when secondary care providers are foundation trusts.
These are services which would be covered by default budgets and to which practices have absolute entitlement.
In order for practices to take on a commissioning budget that includes services outside that area, agreement reached should be reflected in the PCT's local development plan.
However, in order to fulfil their obligation under the choice agenda, and in the context of PBC, practices should not coerce patients into choosing an in-house service.
Dr Kausar Jafri, Trentham, Stoke on Trent.