Oh no, not again - the tired old cliche about commitment being equivalent to the desired degree of control is trotted out. Andrew Wall treats level 4 as being for the 'ambitious', and levels below for the 'less committed'. He then adds insult to injury by suggesting that fundholding is the exemplar of GP interest in commissioning thus far. Please let these myths finally be nailed on the head. It is probably not even arguable that greater commitment was (and is) provided by non-fundholding commissioners, weighted as the system was and still is (and since when did a desire to be in true partnership correspond to a lack of ambition?). Not all ambition equates to power. History often suggests influence is more lasting.

Of course, I may be reading this incorrectly. These days the adjective 'ambitious' is often sleight of tongue for foolhardy, and of course, fundholding did show GP interest - it gave birth (initially) to non-fundholding commissioning.

George Young,

Greenbank Surgery,