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Forget Trojan horse for increased competition, long before the impact of that becomes apparent they're an unimissable Trojan Horse for cost cutting on an industrial scale - in London "Out of Hospital" strategies are being developed on behalf of CCGs by the few remaining PCT staff (plus McKinsey..) which require savings of tens of millions per CCG over the next 3 years - the CCGs will be required to own these and explain to the public how they'll be achieved once major public consultation begins regarding proposed hospital reconfiguration (i.e closures) in a couple of months The strategies are complete works of fiction assuming gargantuan reductions in hospital referrals and non-elective admissions which have absolutely no chance of being achieved. The easy pots of cash have been raided in 10/11 and 11/12, now real savings are needed and no-one has a clue how it can be done. It's like watching a car crash in slow motion - there is frenzied spreadsheet completion on a daily basis comapring this benchmark with that benchmark and creating masterpieces of fiction which magically add up to the savings target. My local CCG looks on bewildered and somehow believes that beacuse they'll soon be in charge, when it comes to the crunch they'll do what they want and these numbers won't apply to them. It's like an NHS "The Thick of It" multiplied by 10 - utterly mindboggling.