One of the many choices that Andrew Lansley had to make when he became Secretary of State in 2010 was whether to develop the GP led commissioning of NHS services that he wanted within the current PCT structure or whether to introduce legislation to develop that policy. Famously he decided that he needed the biggest NHS Bill in history to enact his vision. In making this choice he obviously felt that developing existing legislation would not give GPs sufficient power. To really empower GPs as the leaders of the new commissioning framework he felt he needed completely new structures and legislation.

It was therefore not at all surprising that in the White Paper, Liberating the NHS, the Government made clear their view that GPs would be running this system,