Leading health professionals and commentators have given their assessment of the government's white paper, published yesterday, announcing that GPs are to be handed responsibility for £80bn of the NHS budget by April 2013.
Opinions ranged from the enthusiastic to the sceptical and even the derisive, with the Social Care Foundation saying the plans were "at best a waste of time, at worst a waste of money".
The NHS Alliance was far more positive, welcoming the proposals. Dr Michael Dixon, NHS Alliance Chairman, said: "This is a unique opportunity for frontline GPs and the managers and other clinicians who work with them to make a real difference to the health of their patients, the services they receive and make the best out of limited resources."
The National Association of Primary Care (NAPC) also welcomed GPs' new central commissioning role with enthusiasm.
Dr Johnny Marshall, NAPC Chairman, said: "The coalition's plans provide general practice with a unique opportunity to raise the bar in the commissioning and delivery of care for its patients.
"The occasion will not present itself again. It is vital that primary care clinicians embrace the new world open heartedly to address the clinical and professional challenges ahead."
The British Medical Association (BMA) was more circumspect. Chairman Dr Hamish Meldrum said: "Doctors are ideally placed to help determine the health needs of their local population. Every time they see a patient they have to make decisions about their care, in partnership with them."
However, he added: "Any reorganisation of the NHS must take place in consultation with clinicians so that it does not cause any disruption to patient services or needlessly waste the valuable time of healthcare professionals."
Professor Chris Ham, Chief Executive of healthcare think tank The King's Fund, said: "The white paper represents one of the biggest shake-ups of the health system since the NHS was established.
"While some GPs will seize this opportunity, many others may be reluctant to come forward and lack the skills needed. Setting a deadline for GP consortia to take full financial responsibility for commissioning by 2013 is very ambitious – whether this can be achieved will depend on appropriate support being put in place."
Clear opposition to the proposals came from David Furness of the Social Care Foundation, who said: "Giving control of NHS funds to GPs is like asking your waiter to manage a restaurant. They might know what you want to eat but they won't necessarily be any good at ordering stock, designing a menu or controlling the chef.
"Commissioning healthcare is very difficult and needs a specialised organisation to do it. And the evidence suggests that small commissioners find it difficult to take on powerful providers and reform services.
"GP commissioning risks handing real control of the NHS to vested interests on the provider side, as GPs simply won't have the muscle to drive through change."
He added: "With the prospect of a funding squeeze that will certainly have an impact on patients, this is no time to introduce an ideologically driven policy that forces GPs to become NHS managers.
"Instead the government should be focussing on what it can do to strengthen existing commissioners – PCTs."