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Editor’s blog Wednesday 22 September 2010: Fresh uncertainty over the White Paper's plans

You probably know that we've been big fans of the White Paper here.

And you may remember that last week, we reported on the emerging division among primary care leaders over the White Paper's chances of success. Monday's NHS Confederation policy salon also threw up a range of potential issues.

Now it emerges in the pages of Pulse that the BMA's GP Committee cannot agree how it should respond to the White Paper - there will certainly not be an overt welcome.

Pulse's Ian Quinn and Gareth Iacobucci also report that local medical committees (LMCs) across England have failed to reach consensus, and many will submit separate responses.

At one level, this is simply a fresh folio for the encyclopaedia of Things That Are Not Surprising. There is a new GP contract to be negotiated, and if I were going to be doing that, I wouldn't want to show my hand. (I wouldn't want to show too much arrogance either, though, as Dr Simon Fradd did over the last renegotiation. GPC chair Dr Laurence Buckman took a smarter line, telling Monday night's public-sector-high-earners-yes-bears-do-shit-in-woods BBC Panorama that he had warned the government that QOF would cost them far, far more than they anticipated).

At another, it is going to complicate the process for the government of reading all the responses. This might, of course, be one of the covert objectives, allowing any sense that the response is superficial to become a stick with which to beat Liberatin' Lansley et al.

Equally, it could work the other way. Dr Chaand Nagpaul tells Quinn and Iacobucci that the GPC is split on its reponse; they cite other - though anonymous - sources indicating that the wider BMA membership is similarly divided over how it should respond.

That could be music to Lansley's ears.

QIPP: not getting many laughs
Pulse also have a good story about the need for more savings under QIPP, which notes that PCTs are already falling behind on their cost improvement programmes. It reveals that the NHS London has warned its PCTs to prepare significant spending cuts to present to GPs by mid-October for 2011-12 and 20013-14, having already cut £174 million this financial year.

Pages 21-44 of the NHS London document say ‘London no longer has a legitimate medium-term financial strategy ...  it’s unlikely financial health and clinical quality will be maintained or improved in 2011/12 and beyond’ (without major action).