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NHS has too many masters, fragmented management streams and structures like Primary care, Acute Trust, Community Trust, Mental Health Trust and Social Care which is completely under different management, confusion around co-operation and competition, too many reforms, poor fragmented IT systems, leaders with personal agendas and too many political interference! Current financial challenges and economic pressure should act as a catalyst for everyone to work together, putting patients at the heart of everything we do and we need strong leadership with integrated management structure with clear line of accountability providing service for 500, 000 population with excellent primary and community care, community based 7 days, 365 days elderly care service and the most important single point of contact for triaging for any out of hours service. We also need single paperless medical record.