Primary care trusts.are bound to weigh proposals fairly, but they cannot be compelled by entrepreneurs to make reckless decisions.

In its second broadside of the week, the NHS Alliance has attacked the 'NHS family' for stifling entrepreneurs in primary care.

Quoting Machiavelli's observations on how old orders resist change, it accuses the NHS old guard of meeting innovation with obstruction, disruption and protectionism.

Mercifully, the report recognises that trying to counter this opposition with more regulation would be counter-productive, and instead calls for light-touch interventions to unblock the system.

The suggestion has superficial appeal, but introducing the bureaucratic equivalent of a plunger to complex structures is fraught with risks.

Any organisation fulfilling this role would need formal powers to deal with commissioning disputes, as it would need to adjudicate on whether an entrepreneur was being blocked.

Second, any appeals to this body would almost certainly involve myriad clinical arguments. This would be time and resource intensive, especially when considering innovations that have not been tested, reviewed and benchmarked.

And there would be major political ramifications overlaying any decisions taken, given primary care trusts' desire to protect their role as commissioners.

But most importantly, entrepreneurs cannot claim a monopoly on wisdom. What they see as obstruction could in fact be sound judgement. PCTs are bound to weigh proposals fairly, but they cannot be compelled by entrepreneurs to make reckless decisions.

For the full story, see 'NHS family' accused of stifling entrepreneurialism