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Anon above. I am sure you are right about GPs peril when they become accountable officers. The fact that you rightly point out that PCT CEOs have been unable to control overspends though is hardly a great advert for what a good job PCTs have done.

The problem is the stupid idea of "commissioning". What makes anybody think that you can fully understand and predict a whole countys' complex and interactive health needs, procure highly technical specilaist services (with little technical knowledge), stop FTs trying to make more money, stop GPs referring and make everything cost less each year, despite designing a system which creates more health demand.

Commissioing is just mini centralised planning. You may as well try and do grocery shopping for 1 million people at a time, then complain that people in Kettering are eating too many satsumas. GPs will fall into all the same holes.

Lansley's and DNs approach is not revoloutionary; it is just tinkering.