GPs need to significantly overhaul their skill sets before they embrace commissioning.

Health secretary Andrew Lansley’s letter of last week sensibly reflects this, stressing GPs should “feel under no pressure” to get involved in commissioning until they are ready and that arrangements can be revised as their knowledge grows.

The government still insists GPs will eventually “make the great majority of commissioning decisions”, but the letter leaves the impression that - with a growing emphasis on the role of the national commissioning board, local authorities, other commissioning agencies and healthcare professionals - their role will not be quite as central as originally imagined.

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Lansley seeks to reassure GPs on commissioning