'There seems to be a distinct waning of enthusiasm on both sides, with private providers complaining about inflexibility and complexity and primary care trusts feeling financial pressures.'

The national procurement of private provision for under-doctored areas has resembled a sickly child since its inception. By now it should have been well into the second wave of contracts. Instead, as we reveal this week, after continuing delays and false starts at least half of the six pilots are in danger of being shelved.

There seems to be a distinct waning of enthusiasm on both sides, with private providers complaining about inflexibility and complexity and primary care trusts feeling financial pressures. And yet this was supposed to be a central part of delivering reform.

Additional capacity was meant to be vital to improving - or driving out - poorly performing GP practices as well as, of course, improving services for patients in generally disadvantaged areas.

Choice of primary care provider has been a major theme of prime ministerial health adviser Professor Paul Corrigan over the last year. Indeed his Social Market Foundation paper, published in December, argued that choice driven by extra capacity was a vital 'spur' to the Our Health, Our Care, Our Say white paper.

In the wake of the Commons health select committee's damning conclusions about the lack of evaluation of independent sector treatment centres, does this latest stumble herald a more general retreat? Certainly it might see a shift from central prescription to greater local control, at least at the level of individual strategic health authorities.

Meanwhile a problem that is as old as the NHS itself and which is a key source of frustration for many PCT managers looks no closer to being solved.