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It sounds as though the RCN and BMA have won the day - the patient voice has been lost somewhere in these proposals, but staff will be a lot happier.

And the glaring potential for conflicts of interests through icluding providers in decisions about commissioning, as highlighted on PM has not gone unnoticed, hence the reference to a dog's dinner.

Why the Lib Dems are hailing a vctory when the proposals mean that they will be well out of the picture by the time this evolution is supposed to have happened is anyone's guess.

I'm sure I'm not alone in finding this whole mess hugely disappointing.