If clinicians are the likely generators of the ideas that will transform NHS performance, managers need the confidence to create the space for them to blossom. Our main feature this week looks at a group of very different ideas with the potential to make a huge difference locally and nationally.

If clinicians are the likely generators of the ideas that will transform NHS performance, managers need the confidence to create the space for them to blossom. Our main feature this week looks at a group of very different ideas with the potential to make a huge difference locally and nationally.

For instance, national primary care director Dr David Colin-Thome makes a powerful case for incentivising the transfer of healthcare from hospitals to the community by giving consultants much more direct control of budgets - a lever that has worked to good effect in US organisations like Kaiser Permanente. Shared budgets between consultants and GPs could be a key driver of achieving the shift. As he points out, there is nothing to stop trusts doing this at the moment - but implementing it will mean imaginative negotiation.

Meanwhile, eminent doctor Karol Sikora makes the case for rethinking the provision of cancer services in the UK through a series of partnerships between NHS and private providers. These would enable the creation of outpatient 'cancer hotels' linked to existing hospitals.

Other contributions include lessons from the US not-for-profit sector in developing clinical leaders, better use of theatres and how one trust is reshaping 'doctor/manager dialogues'. By themselves, these ideas will not transform how healthcare is delivered, but as columnist Simon Stevens pointed out last week, now is the perfect time to show local initiative with innovation and imagination.