We are facing the “Biggest revolution in the NHS for 60 years [3]” as the Telegraph put it. It means that £80 billion spent for hospital care will be transferred to family GPs, which could eventually make untold thousands of NHS bureaucrats redundant. Excellent move! However, this has been tried before under the label of commissioning by the Thatcher government with very ambiguous results. The lessons of that experience must be acted upon. One problem with commissioning that needs to be borne in mind is that is can simply increase the dependency of patients on the judgments of a single doctor. Adn there must be a worry that a solitary GP will have difficulty keeping up-to-date with all the medical disciplines required to make these judgments.

Furthermore, the patronizing and intrusive nanny state only adds only to the burden on GPs – something we should consider carefully now we are asking them to take on such a major role. There has to be some relief: at least put the patient/family in charge of the private aspects of his/their own health, by giving them the funds to do that. Mr Lansley should put an equivalent of several thousand pounds in health savings accounts, managed by every patient to fund their non-hospital health, preferably including a budget for medication. Patients could also book their surgery appointments online and free many thousands of receptionists for administration of the commissioning. This would be the perfect quid-pro-quo between doctor and patient and would also rid the government of any role of interference in our lifestyle, while making many more thousands of bureaucrats redundant.