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The moribund nature of the commissioning system is truly exposed by this saga, and it is probably time to close the internal market. What is the point of a PCT/CCG if (a) its contract monitoring is not allowed politically to tackle the fundamentals of unnecessary deaths, poor clinical care, and clinical negligence and (b) when something goes wrong, the local commissioner is never held to account by the media or external reviewers - ie there is no expectation among patients and rev that the commissioner will have intervened. If local commissioning is not to be given teeth, better to scrap it and save a fortune, some of which could be ploughed into 24/7 working.