Leading article: Doctoring the National Health Service

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Most people now agree that the Government's decision to ring-fence the National Health Service while forcing almost all other departments to accept 25 per cent cuts was a bad idea.

But £20bn in savings will nonetheless be sought within the NHS budget by 2014. And the abolition of Primary Care Trusts (PCTs) is the big efficiency reform being pushed. The word is that the responsibilities and powers of the 152 PCTs will be devolved to around 500 local consortia of GPs, which will commission health services for patients across the NHS. A White Paper has been promised for next week by the Health Secretary, Andrew Lansley.

The theory behind the reform is that GPs are best placed to understand patients' needs and to decide where money should be spent. Mr Lansley wants demand for services across the NHS to be shaped by small, smart groups, rather than large, dumb PCTs. He hopes this will result in less money being wasted and an NHS more responsive to patients' needs. There might, however, be a rather baser motive in all this. GPs were given a ridiculously generous pay contract by the last government in 2004. Perhaps Mr Lansley thinks it is now time for doctors to earn their rewards.

But putting 80 per cent of the NHS budget in the hands of GPs is a gamble. What if GPs do not want to be managers? Many were only too pleased to get rid of the responsibility for providing out-of-hours services in 2003. Now that will return along with many other new duties. Do GPs have the necessary skills to handle it? The White Paper needs to lay out what happens if these consortia overspend.

The chief executive of the NHS Confederation, Nigel Edwards, has said he expects GPs to recruit former staff from PCTs to enable them to cope with the additional workload. But unless GPs take the lead, this reform could simply reinvent PCTs under another name and on a smaller scale. Paradoxically, Mr Lansley's reform could end up being a big failure, or a big fuss about nothing.

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