Professor Alan Maynard decodes the White Paper’s literary and political influences

The primary characteristics of the recent White Paper on the NHS, Equity and Excellence: Liberating the NHS are incoherence and ambiguity. The consultation papers that have emerged subsequently do all too little to reduce the conclusion that Chairman Lansley is not sure where he is going.

’Incoherence and confusion are both an opportunity and a threat.’

This story on the £8 billion potential value of the sale of goodwill in GP practices, by HSJ's smart news editor Sally Gainsbury, made me think a little about the changing dynamics of the system.

The sale of the goodwill in a GP practice - the projected income and profit - is essentially the registered list. It is forbidden to sell this, at the present time.

Irwin Brown of the Socialist Health Association looks ahead to a post-restructuring future

Come with me into the future of Andrew Lansley’s imagination.

It’s OK, you can hold my hand.

Imagine for now that the changes in the DH structural reform plan actually happen as planned.

The remaining acute and mental health trusts somehow overcome the obstacles they have faced for the last six years and become FTs. Those few PCT provider arms which are not absorbed by the nearest acute or mental health trust also become FTs.

What a week for letters it's turning out to be. Below is the text of BMA chair of council Dr Hamish Meldrum's letter to his guild.

"Dear Colleague,

"The publication of the health White Paper will, no doubt, have left you with many questions about the impact this is likely to have on you and your patients.

This BBC news story suggests a big old review lies ahead for NHSScotland.

No ring-fence could mean a lot of politically unpopular pain.

And effective loss of the Scots' historic gain under the Barnett Formula.

To borrow HPI new recruit Doctor X's marvellous phrase, this new 'Dear Comrade' letter from NHS Czar-In-Chief Sir David Nicholson puts some scant flesh on the bones of how smartly the service can now start shutting things.

In a GP commissioner-led manner, naturally.

Lansley's 25% genuinely measurable reconfiguration tests

This BBC News story trailling a Radio 4 The Report broadcast this evening, shows commissioning in action. It also functions as a free ad for the European Scanning Centre. And it describes a wholly sensible approach to GP-led commissioning, which will destabilise local acute providers.

What's not to like?

True, the commissioning is not wildly sophisticated. Wildly sophisticated commissioning would be getting a London-wide (or at least multi-PCT-wide) contract for appropriate, targetted CT scans.

The Radcliffe paediatric surgery review is published here.

One-liner - the service is suspended until it can be safe - i.e. probably forever. Preface and exec summary copied below.

Preface

The Telegraph has an authentic-looking leak of the Oxford paediatric heart surgery review

The Guardian has some union-led outrage about the cost of interim managers at Dorset General Hospital FT.

Unbelievable.

Well, that'll be the end of all discussion about Ubani's proven incompetence, then.