Nicholson told the NHS Alliance conference he believed there had been collusion between GPs and PCTs to prevent a growth of the number of doctors in poorer, under-doctored areas.

Giving one of the keynote addresses to the NHS Alliance conference, Nicholson repeatedly emphasised the importance of primary care. However, the strongest message of his speech was around the poorer areas of the country, where access to GPs is lower because there are less GPs per head of population.

Several delegate questions from the conference floor were critical of the proposed new 'polyclinics'. Polyclinics are GP-led health centres providing primary care and a range of diagnopstic tests, as well as outpatient clinincs and also possibly minor operations , open 8 am-8 pm, seven days a week. Every one of the country's 152 PCTs will have a poloyclinic, and some hospitalds - most notable University College London Hospitals NHS Foundation Trust - are planning to open and run a polyclinic.

Nicholson told delegates, "in my career as a NHS manager, we tried three times to get increased capacity to under-doctored areas across the country. What happened was that it failed three times. A cosy conspiracy of PCTs and general practice overcame it. This (the move to polyclinics) was at the end of that process."

Struggling to rise to the level of collusion
However, Dr Michael Dixon, a GP and chair of NHS Alliance, suggested in a subsequent press conference that "I think it's a bit unfair to say that PCTs and GP practices colluded. The relationship between GPs and PCTs (or tyheir predecessor organisations) has long struggled to rise to the level of conspiracy".

Dixon continued, "frankly, I think some of the problems in practice-based commissioning are because they don't collude enough." The conference also heard fresh assurances from Deprartment of Health director-general of commissioning Mark Britnell that GP practice based commissioning would receive fresh attention and impetus, including guarantees that practice-based commissioners have rights to clinical information, management information, management support and financial support - with new invcentive freedoms for advanced PBCers who want to go further faster.

Britnell noted that obvious barriers remain to PBC progress – clarity of roles and responsibilities; capability and capacity for PCTs and PBCers; poor governance; confused relationships; motivation and engagement.