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It's not red tape, it's consistency with the way the rest of the healthcare market is treated.

For any market - and patient choice - to be effective, it cannot become dominated by even larger suppliers.

We may not like the transition towards market-based ways of working but ultimately there either IS a market for NHS care or there isn't (and, again whether we like it or not, the decision has already been made that there is/should be).

As an aside, I wonder how long it will be before NHS FTs are treated as "external" suppliers to commissioners and placed outside the scope of in-house/direct awards of business?