Although this Government White Paper will only be applied to England (and Wales?) the consultation process on it has spread throughout the UK. So here's my Scottish, primary care perspective on it all.
Firstly, let me say that I believe that doctors do not make good managers. That belief is based on 20 years of experience of Trusts, LHCCs, medical directors, clinical directors, etc.
I know that this White Paper is not intended to be Fundholding mark 2 but let's not beat about he bush - in my view Fundholding Mark 1 sucked and there are enough hints in this paper to suggest that we may end up with something along the lines of Fundholding Plus.
GPs are not really an altruistic bunch when it comes to the crunch and fundholding demonstrated that in the raw. There were a lot of GPs and a lot of practices quite happy to do things under fundholding knowing that they were shafting their colleagues and neighbouring practices in the process. The resentments of those days are still evident today.
I have seen nothing that convinces me GPs will make good commissioners. GPs are not good at looking at the bigger picture - secondary care has little idea of what goes on in primary care but the reverse is also true.
In my view, at a macro-level, health policy should be determined by politicians and civil servants in discussion with the BMA and Royal Colleges. That's what appears to be happening superficially at least with this White Paper and that's fine.
In GP land the two big issues are QOF (quality and outcomes framework) and enhanced services. QOF should be determined at a macro-level as above - and remember it was doctors who gave us the more controversial aspects of QOF (chronic kidney disease anyone?).
The only role I see for GPs is at the micro-level - this happens already, to a greater or lesser extent with enhanced services, but I do see a bigger role for LMCs in that respect. But what other role do we perceive GPs having? Do we really want GPs to decide if the new community physio is employed for 13.5 or 17.5 hours per week or whether the community nurses should be resticted to one pack of incontinence pads per week or whether Zoladex should be removed from the local formulary or whether there should be four or six out reach Ophthalmology clinics per year? Such is the stuff of management and I for one want no part of it thank you very much!
 
Interests to declare: member of Scottish Council RCGP and no fan of the Tory Party (so not very objective really)