'Central and Greater Derby primary care trust deserve congratulation for innovating in a way that promises to improve the quality of services.'

It shows just how much the ground has moved on independent sector provision (and indeed how much the Conservatives have moved) that one of the few controversies of the Tory conference was Oliver Letwin denying he had said there would be 'no limit' on private involvement in the NHS. If he?s right, that arguably puts him to the left of the health secretary.

This topsy-turvy world will prove controversial for some time to come. As we report this week (news, page 5), McKinsey has had to defend its involvement in planning the Department of Health's strategy for a market in commissioning. Not all on the shortlist of bidding companies are happy that the same organisation that sought their advice will now be competing with them.

In contrast Central and Greater Derby primary care trust has grasped the nettle of independent primary care provision with its deal with UnitedHealth Europe. It involved 'taking some risks and holding our nerve'.

They deserve congratulation for innovating in a way that promises to improve the quality of services, especially when the neighbouring PCT had so much trouble with its own UnitedHealth deal.

In the week that saw the birth of a new generation of PCTs - and in many minds saw the premature ending of the contributions of hundreds of managers - it is important that they have the navigation aids they need to chart their way through unstable seas. Otherwise innovative risks can quickly collapse into dangerous experiments.

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