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and the same is true of the new NHS commissioning systems. CCGs and CSUs forced to be lighter than PCTs have cut their cloth to a new budget with no time to redesign better ways of doing things.

There's lots of fluffy talk within emerging CSUs about new ways of working and more private sector style focus on productivity and performance management, automation, standardisation etc. But scratch the surface and the basic plan is simply that the people left will have to cope.

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