Editor’s blog Monday 4 October 2010: Nadine Dorries MP says most GPs have no idea how White Paper's commissioning will work

Former nurse, Conservative MP and Health Select Committee member Nadine Dorries is without doubt a person who adds to the gaiety of the political classes.

Health Service Journal editor Alastair McLellan has been tweeting from the Conservative Party Conference, reporting Dorries as telling a fringe meeting, "(it's) my job as MP to follow constituents wishes if they want to save their local hospital"; "the ambulance service could be outsourced to deliver big savings"; and "regional centres of excellence don't work on a human level".

So far, so fun.

'The majority of GPs have no idea how commissioning is going to work' - Nadine Dorries MP

Now on her blog, she writes that "I have realised something quite profound, the majority of GPs have no idea how commissioning is going to work.

"I have said before that if I were a GP, I would be excited about the opportunities that the abolition of the SHA and PCT would present in order to enable me to 'think outside the box' in terms of the provision and service I would be able to provide to patients and the opportunities it would provide for GPs, to extend and enhance their own practice based skills.

"As you explain the reality of the NHS commissioning board for specialised services, the role of the Local Authority in the provision of public health and the opportunity the consortia will provide for each practice, its like watching the scales fall away from their eyes.

"I am about to write an email to Andrew Lansley. GPs are enthusiastic and love the idea, but are short on information and explanation and that's something we need to address".

Mmmmm.

As well as the admission of the screamingly obvious - that most GPs, the people meant to wield the new power and alter their clinical practice, are simply devoid of any convincing story about how they new system is going to work, thanks to Lansley and colleagues' narrative - it also strongly implies that a skein of Conservative thinking believes that GP "provision and service" - doing more - is what the White Paper is about.

This is a bit of a concern. GPs are lovely (although I couldn't eat a whole one), and the importance of good primary care in healthcare is well-evidenced - although our evidence base for performance in primary care in the NHS is far from fantastic (meaning that telling good GP performance from bad is a challenge).

And certainly, if more care is going to be delivered outside hospitals, that will mean one of two things.

Either preventative care will improve so much as to actually decrease the stock of population ill-health (quite an ask, living as we do in a generation getting fatter and drunker); or what was formerly delivered in secondary care will be done in primary care or even the patient's home, using widely-available technologies to support self-care.

The latter option sounds good unless we get to the done in primary care bit - if it is to be done by GPs. Workforce substitution in primary care has a reasonable evidence base for safety, and a good evidence base for patient acceptability.

I conclude by repeating Nadine Dorries' own words for your edification: "if I were a GP, I would be excited about the opportunities that the abolition of the SHA and PCT would present in order to enable me to 'think outside the box' in terms of the provision and service I would be able to provide to patients and the opportunities it would provide for GPs, to extend and enhance their own practice based skills".