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I think Andrew Bruce at 8.45 above may get what he asks for when he proposes a more centrally run system. Of course the SoS talks of localisation and power to GPs (voters and clinicians are suckers for a bit of flattery) but what we will almost certainly get is a more centralised system: a single National Commissioning Board in place of nearly 200 PCTs and a smattering of GP consortia (read worthy but commercially skill-less and impotent talking shops with lots of bow ties) under that. The NCB will do all the heavy lifting and will report more or less directly to the SoS. Lets just hope the NCB is good!