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What Mr Lansley said at the conference this week made sense - GPs initiate much of the costs in the NHS, so let's put them in charge. The worrying thing is that when asked, he had absolutely no idea how they would be made accountable for their actions. He has no doubt told DoH hobgoblins to think of a way - risking the old top-down, process-driven meandering we have seen too often over the last decade!