by Andy Cowper

Some concluding thoughts from Confed

1. Every big conference has an atmosphere: a reflection of the mood across the service. This year the atmosphere has been elusive. Conference chair David Walker, editor of Guardian Public characterised it as “calm”. Calm was a symptom, but the cause was waiting. We are all waiting for Darzi.

2. Even Andrew Lansley, with his masterful command of the NHS brief, couldn’t stop the drift away on the last day. This was a pity, because the session afforded the chance to ask him how the Conservatives had derived their numbers of GP surgery closures.

His reply was intriguing.

“Our figures on GP surgeries were that up to 1,700 would close. Broadly 1,000 in London – we based this on the ‘Framework For Action’ document’s numbers of 150 polyclinics in London with 25 GPs each. The implication elsewhere was that we thought 600 would shut ifthere’s a polyclinic in every PCT. Then on Tuesday in the Commons, Alan (Johnson) said that polyclinics won’t have 25 GPs but 5. I don’t know where that figure came from. so technically speaking you could scale back the effects we predicted. But with the 58 PCTs who’ve published memoranda of understandingfor GP-led health centres, that would add up to add up to another 600 GP surgeries closures”.

Now I’m not an economist, but this looks suspiciously like what was characterised in Yes Minister as “round objects”. Assumption number one – that you can scale up from one-third of PCTs to create a national figure. Mmmm. Assumption number two – that polyclinics/GP-led health centres will cause every GP practice in the vicinity to close. Double-mmmm.

And didn’t his piece about getting 70-80% of staff spontaneously speaking highly for their organisation sound suspiciously like a national target of the kind the Conservatives want to sweep away?

3. The view from the Hilton hotel’s bar of the Manchester skyline is stunning.

4. Clinical (dis)engagement is probably the single major issue facing the service. There were sessions touching on the issue, but it didn’t feel like a major issue to many of the keynote addresses. Honourable exception mention to Mark Britnell, who seems serious about practice-based commissioning.

5. Hamish Meldrum, who emphasised that the BMA had not put figures on GP practice closures, struck the most conciliatory BMA position of recent times, stressing that the BMA is not against polyclinics “anywhere”. Good negotiator, that man. There might yet be some room for sanity going to prevail in this debate. Can somebody take away his pen and Ben Bradshaw’s, so they stop writing each other nasty letters?

6. Liverpool? Can’t we go to Paris? Please?