Alan Legerton, 62
Full-time carer for his wife, Lynne, also 62, in Hereford

I've been my wife's carer for 17 years. She's had a succession of strokes, has severe epilepsy and is unable to feed herself. I don't have any respite care but I do have an agency carer in the mornings and evenings, funded by social services. There are times when my GP has contacted social services on my behalf - like when I had back trouble and was worried I couldn't look after Lynne - so if my GP had more influence over social care, it could make a real difference to our lives. I'd welcome my GP prescribing respite care, which is vital for carers' mental and emotional wellbeing. As a user of health and social care services, at the moment I can't see social services and the primary care trust (PCT) working closely together at all, but maybe a new way of working might change that.

Ray Jones
Former director of social services, Wiltshire county council

Having creative local commissioning and purchasing is a good thing, but whether this should be in the control of GPs is another matter. GPs are primarily clinicians and have extreme workloads and, although they can commission sensibly for the promotion of health - such as exercise opportunities - I'm not sure they're best placed to be commissioning for social care. Social care is about assisting people to do the things they want to do within the limitations of their daily lives, and that is much broader than thinking about people's emotional health. Some might ask if this is a sign of routing social care funds through the NHS. It's recognised that social care has been underfunded in a major way and that the NHS has had some considerable increases in funding but with limited benefit. At some stage the nettle has to be grasped and funding must come to social care direct rather than through other agencies.

Helena McKeown
GP and chair of the British Medical Association's community care committee

The devil's in the detail and, as yet, there is not much detail, but GPs are potentially excellent commissioners of care because of our traditional role of being the patient's advocate. GPs visit patients in their homes, they get to know everything about a person's physical, psychological and social needs, and they have a view of a patient's whole wellbeing. Many people haven't made provisions about their social care because they don't realise there's a difference between healthcare and social care. Patients find it hard to understand this artificial division - for example, is washing a patient a healthcare or a social care need? I'd argue that if they're unable to wash themselves, then it is a health need. Commissioning social care will give us some opportunities with regard to the voluntary sector, we could part-commission voluntary sector agencies such as Age Concern to provide services to patients.

Mike Dixon
GP and chair of the NHS Alliance

Commissioning social care could help prevent patients going to hospital, so people are going to have to think out of the box. There will be some local authorities that will start trying to get GPs to pay for services that they should be paying for themselves, but then again, there are real limits on what local authorities can pay - so there are gaps that maybe GPs commissioning social care can fill. It's an exciting era, this really is a fantastic opportunity for us to really change things for the better. That's our role as GPs and so far we've been far too limited in what we've done and what we've been allowed to do.

Ian Johnston
Chief executive, British Association of Social Workers

I have some sympathy with the view that people who require a range of help in social services shouldn't have to jump through any more hoops than is necessary. However, for the most part GPs confine their activities to diagnosis and treatment of illness and refer other matters to paramedical colleagues and social workers. Their capacity and indeed willingness to participate in child and adult protection conferences remains variable. By and large, the services they prescribe are demand-led and free of charge. The provision of social care by local authorities follows assessment of social circumstances and strict application of eligibility criteria. It's therefore difficult to see how these proposals will work in practice, and to equate them with the drive to relieve GPs of some of their clinical responsibilities through measures such as nurse prescribing and NHS Direct.

Anne Williams
Vice-president, Association of Directors of Social Services, and strategic director of community health and social care at Salford city council

The proposals are positive, but need to be thought through further. For example, it's vital that any GP commissioning is consistent with joint PCT and local authority commissioning strategies. The big issue here is that, at the moment, health services are free but social care is not, so there are practical challenges. You could have a situation where one service user's social care is commissioned and purchased by the GP, but someone else in the same area receives similar support from social services, not the GP, and so pay for social care themselves. We don't want to end up with a postcode lottery or to destabilise joint commissioning strategies.

Gordon Lishman
Director general, Age Concern

Giving GPs more opportunity to help patients remain healthy and independent, by offering a wide range of preventive services, is a real step forward. Artificial barriers between health and social care have worked against getting patients the right preventive services. In the last 10 years, we've seen cost-shunting between health and social care that has resulted in the widespread withdrawal of the preventive services. Focusing on prevention, and looking at the entire needs of the population is the only way forward. The government has made a step in the right direction by allowing the NHS money that has traditionally been locked into acute services. The government needs to make bolder, properly funded steps to improve the system - £8.9m [announced last week as part of the communities for health pilots bringing together councils, the NHS and community groups to improve health in disadvantaged areas] is just a drop in the ocean. The comprehensive spending review is the opportunity to put real money into the system to begin the process of a better and fairer long-term care system for older people.

Imelda Redmond
Chief executive, Carers UK

If you're a carer, you don't care about the source of your support, as long as it is the right support at the right time and it's uncomplicated. I can see some attraction in GPs offering breaks to carers as they won't have to go through the formal assessment process. The more barriers you can move to help delivery, the better, and it's often easier to access your GP than your social worker. However, one complication I can see is that social care is delivered at a charge and is seriously rationed, but GPs don't charge and I can't see how that will work. Much of the time the care you get depends on what is available, and the service offered suits the service provider rather than the family. So you do need plurality of service provision to deliver what people need.

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