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Anon 2.50, this is a fantastic summary of CCGs in my region too. Plans are written by Hansel and Gretel - fairy tales. Then when they go off track it's death by spreadsheet. I'm reminded of a former PCG CEO who said in our first meeting "we've got all this money, would you like to come and play" to the local GPs and trusts. It was all committed (even in those glory days of 6% growth) and/ or overspent on whizzy schemes. GPs thought they could tinker at the edges with PBC schemes that didn't really link up but then again, they didn't want to be involved in some tough choices. I think once they see the books for 13/14, they'll run and contract it out to someone. Hopefully our local CSU with all the experience, not McFirm....