David Colin-Thomé took the after lunch slot but was not as stimulating and provocative as he can be. Perhaps it was because he didn’t have much new to say, perhaps also his slides were especially soporific. He laid out the familiar central market stall of improving access (capacity), personalizing care (choice), public health, chronic disease management (based in the community), etc., but there was little insight into ‘how’, and whether the good ideas and pilot projects would scale sufficiently in the real world. For those based in secondary care (most of the delegates), the world of which he spoke seemed rather remote from how it feels on the ground.
There was some discussion about the ‘gatekeeping’ role of primary care and how this has never been a formal role, but one which simply arose from the fact that when something is wrong we usually see our generalist GP first, who more often than not can deal with our problem completely. The introduction of ‘payment by results’ will, he felt, actually increase this gatekeeping role, though he was not impressed with the possibility that his PCT’s commissioning agreements might actually prevent him from referring a patient to the specialist of his (or the patient’s) choice.