“If you feel confused you probably know what is going on.” 

Out in PCT land it is fascinating to watch and listen to all the noise and thunder in the stratosphere.  The pause is in full momentum. The events of May 5th are having repercussions with posturing and postulations about substantial amendments to the health bill. But so much has already happened it is hard to see how much of the genie could be put back in the bottle.

PCTs have been clustered, staff made redundant, elections have taken place in consortia, senior staff have been aligned, and staff are being assigned. Plans have been made predicated on the establishment of an NHS commissioning board and to put consortia in control of local commissioning implementation. Specialised commissioning groups are being reshaped and public health is…..

I met a public health doctor recently who alleged, “The attitude in local authorities is that public health will be de-medicalised. Doctors are too expensive.  They are putting directors of public health 2nd or even third in line to the chief executive of a local authority. Why would any doctor want to go into public health?” A depressing story from a disillusioned, experienced, and skilled public health doctor.

Moving from frontline clinical practice into commissioning, as I have done, I have learnt to respect and value good public health. Dismembered, it will be hard to resurrect, yet what is happening to it seems to be being overshadowed by all the shouting about competition and use of the private sector in the NHS.

There are massive changes also being made in training and education, yet these also seem to be almost being ignored in the tumult.

The changes wrought in the last few months to PCTs have neutered non-executive directors, deconstructed PCTs, and centralised commissioning in a manner which has to be experienced to be understood. Consortia are there to implement a national framework and maybe that is no bad thing. The NHS is becoming a national commissioning system. National standards, national frameworks, and central direction will be the context within which consortia operate.

So it will be interesting to see if once the pause has finished and the dust has settled people realise what is left to substantially amend.

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.