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I knew I was being facetious about the "icepick" effect of the move from coterminous PCTs to clusters but that was how it felt at the time - something brutal was being inflicted and there didn't appear to be a great deal of thought going into the reversion to what are, effectively, nineties-style health authorities. Rationally, post-election something had to happen to PCTs due to the financial position of the country and of the NHS, with PCTs and managers as an easy target for savings. Given the time limits placed on clusters (subject to change post-"pause"), I wouldn't be so sure that the upheaval and impact on morale of those left in post will pay off.