The NHS, always in danger of becoming every health secretary’s trainset, faces yet another major reorganisation. The idea is that GPs will lead the quality and safety and value for money charge that will be needed over the next five, perhaps 10, years.
They will go from virtually a standing start, in the knowledge that there is only a modest enthusiasm for a similar opportunity already in the system: practice based commissioning.
They will be supported in this ambitious undertaking by loyal civil servants and managers who will lose their jobs and are already shouldering their crosses on the road to Calvary.
And a whole lot of other things, too numerous to mention here, will be going on at the same time involving removing, reshaping and replacing multiple other organisations and their functions within, on the fringes of and nominally outside the NHS. It is impossible to predict how this will look and whether it will succeed.
Across the land GPs are stunned and divided. While some are energetically thumbing through swatches of bright coloured lycra, wondering how best to get their underpants on over their trousers, others are busily working out where they hid the stash of kryptonite that worked so well in the past on previous would-be NHS superheroes.
GPs promoted from goalkeeper to centre-forward, how did that happen?
According to some this is the biggest thing ever to happen to the NHS and it is massively risky.
Will it fly? It is a good question. Will GPs be like Superman, effortlessly orbiting Earth faster than the speed of light to control time, or more like Icarus with his home-made wings, ignorant of the melting wax and with overblown expectation?
How much will it cost? Start by thinking of every tragic, wasteful extravagance that has scandalised the NHS and then multiply it by a lot. £1.7bn trips off the tongue. Try this: £1,700,000,000. It’s a big number.
In any media currency equivalent it is hard to get your head around it. It may be six new hospitals or enough nurses to fill a football stadium night and day for a very long time.
Realistically £1.7bn could more than pay off the debt of the 30 hospitals said to be facing financial difficulties which is standing in the way of achieving foundation trust status. It would give them a chance to aspire to income and expenditure balance, a more realistic ambition in the current circumstances.
The medical profession, including its union the British Medical Association, is justifiably seized with uncertainty. So are the nurses and the commentators. Academics point out that nowhere else has an identical system been implemented or evaluated.
For some GPs, prepared to overlook the usual medical plea for an evidence base, it is just what the doctor ordered. Many are nervous that the challenge is too great and the time to implementation is too short. There are large numbers who will be required to get involved, even if only to support their leaders, who are not much interested at all.
Sometimes a revolutionary idea is so original and audacious; think of Harrison’s clock, it is hard for the majority to grasp its brilliance. This is not one. This is the Sinclair C5. This is the Dyson hand dryer, at best a decent attempt to making best use of the “blow” after all the creative and original possibilities of the “suck” have been exhausted.
Before everyone’s position becomes polarised and the debate deteriorates into damaging words and deeds from which it becomes difficult to retreat there is an opportunity for reflection.
The consultation has ended. There is sufficient concern from a large enough cross section to justify a less risky implementation timetable. Surely the ambition could be allowed to be refined over a longer period with benefit from experience on the ground and avoiding the possibility that patient care becomes the victim of hostilities?
We could do a lot more with the £1.7bn and all the effort and energy and goodwill that delivering this plan will wring from the system.
Reckless action now would be a risk to the NHS and the health of the nation. When the mists cleared there would be, history suggests, a different secretary of state, a different set of problems and a very large number indeed of very unhappy people all mouthing “I told you so”.