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The trouble is incoherance. Lansley may well "care about the NHS", but the concept of the NHS is incompatable with general philosophy of the conservative party and of these reforms. As is any form of local commissioing (PCTs or GPs), or patient choice as a market lever.

What did PCTs do: Did they plan local services, or enforce DH targets and try not to run out of money?

If you are going to make commissioners very accountible to the centre - you will just have PCTs again (and they failed- right?)

If you lose the accountibility - then unelected GPs are in charge of taxpayers money.

Lansley needs to go; either in favour of someone who will re-introduce DHAs and forget commissioing, or someone who will turn us over to a regulated social insurance based system.