John - What do you think the coalition government will do about Practice Based Commissioning? The Tories seemed to be commited to a model that is closer to fundholding. In the 1990s fundholding appeared to generate efficiency savings, although they were outweighed by start up costs (Audit Commission 1996). Presumably the start up costs would be much lower now, as much of the managerial expertise and IT is now in place. A key issue would appear to be incentivising GPs to engage in this process; something the PBC model has failed to achieve, (King's Fund, 2007, 2009). Will Cameron grasp the nettle and allow GPs to profit directly from efficiency savings, or will Clegg veto this?