the troubleshooting, the performance management of commissioners and providers, the evaluation...... it will be the PCTs and poss the SHAs to lesser extent ... and who is going to do that when they are gone? The government make a lot of noise about ' sweeping away bureacracy' and insultingly, ' penpushers' - but they are deceiving you all, as most of these functions will have to continue, and be done by someone - enter the private, commercial companies circling like hungry vultures.... and do you really honestly believe they are going to be motivated by the same things as public bodies like PCTs? Let's face it, they are private sector for a reason and that is to make a profit. Just imagine what this is going to do to commissioning - and what it does to commissioning today it does to your health service tomorrow... I fail to see how a scantily populated rural area where gps are already doing far more than in more urbanized regions serves as a pilot for a radical NHS transformation. Further, changes like broadening gp authority to refer patients directly for diagnostic tests like MRIs or elective procedures without working through hospital consultants should have been undertaken years ago and have nothing to do with commissioning/fundholding per se, but rather the organisation of medical services. Likewise peer-led practice improvement is commonplace elsewhere in the world and can be grown (probably more effectively) on soil where the doctors are not financially implicated in patient care