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Oh for heavens sake! You spend a fortune inventing a half cocked "market" for commissioning support and then before it has had even a few months to bed down you start to dictate to the supposed "consumers" what they should be buying from it.

I'm also a little confused as to why NHS England seems so conviced that in-house services, rather than bought-in services, are less likely to be delivering transformation. Where is the evidence for this please?

I can't help but get the feeling that there's some genuine panic in the corridors of the DoH that their insane plans for "commissioning organisations that don't so much commission services themselves but rather commission other (preferably private) organisations to commission for them" is starting to unravel.

That was the point of this whole debacle after all wasn't it? Shifting a sizable chunk of the commissioning bureaucracy into CSU's that (once contracts were awarded) would then be snapped up by the big consulting firms, reducing the public sector pay bill and pensions liability?

Having the GPs get all independent on you and make their own decisions, forcing you to get all authoritarian on them and get NHS England to boss them around is going to be embarrassing for a health secretary that has spent his entire time in office banging on about how GPs were the only people to be trusted with decision making in the NHS.

Shame.