930 British Journal of General Practice, December 2010

commissioning consortia If GP-led commissioning is to realise its potential to re-shape the NHS in ways that serve patients better, facilitate care in and around people’s homes, and strengthen general practice, GPs and all those working in the NHS need to understand its basic principles. The key rule is that NHS money is now real money. GPs need to be aware that every prescription or referral is a commissioning decision. Until now we hardly felt the consequences of overspending on prescribing and secondary care budgets. How we spend NHS money will now have financial consequences for us. This will revolutionise vocational training when trainees will need much closer scrutiny by practices to ensure they are not wasting money. We need to teach and demonstrate that: Value for money = Effectiveness Cost As ‘pathfinder commissioners ’ we have to ask ‘why has the government chosen general practice to be given this prize?’. We believe it reflects an appreciation of two key attributes of general practice: • GPs are trusted by patients as their advocates; and • UK general practices are generally effective, efficient, and financially prudent. The former will test our relationships with some patients and it is vital tha