I have taken my eye off what is happening with Darzi centres - or polyclinics - or 8-8 GP-led health centres - or APMS centres. Which was unwise of me. The profusion of names should have given me a clue.

The basic concept - of creating something to enable improved access to GPs, primary care and diagnostics, particularly in poorer and traditionally under-doctored areas - was a good one. The roll-out - with the Sir David "look out to your communities, not up to Whitehall" Nicholson DH ordering every PCT to create one - was guaranteed to put some in the wrong places.

This report from Healthcare Republic, quoted Dr Ken Megson's speech to the BMA LMC meeting, in which he revealed that his Darzi centre, the Medicus Practice in Gateshead, was failing to attract patients and wasting money.

Only 250 patients have registered at the Medicus Practice - well below its target of 1,500. Dr Megson contrasted the result as giving funding, in effect, of £816 per patient, in contrast to the generally weighted GMS sum per patient of £64.

The article quotes Dr Megson as saying, "it's an absolute disgrace to be getting paid this much money for doing nothing. The PCT won't publish the costs, but I will". It also says he described information about the costs and benefits of Darzi centre' as "not commercially sensitive, it's commercially embarrassing".

Dr Megson clearly has public service values a mile wide. He and his colleagues could have sat around having a nice easy working life and coining in the money. He has highlighted a ridiculous situation. The PCT, NHS South of Tyne and Wear, should be concerned if they failed to spot this low take-up of the service they commissioned.

It comes on top of this report, also from Healthcare Republic, on how Aspect Health, which runs the Darzi centre service at the Sherdley medical centre in St Helens Hospital, targeted elderly patients of local GPs to encourage them to switch to its services.

The Aspect Health Darzi centre sought patients with limited mobility, writing to encourage them to switch from their GP and highlighting its 'ElderCare' home-visiting service.

The article rightly notes that DH guidance prohibits advertising NHS-funded services as superior to those of local NHS providers. In fairness, this is a bit of a nonsense, and would probably not withstand a robust legal challenge.

The more serious point is that continuity of care is very important for the most sick patients - often the elderly, and very often the elderly with restricted mobility.

If Aspect Health have such faith in their home visiting service, they should find GPs happy to refer to it or commission it - without directly mailing their patients.

Both stories highlight a dynamic tension that will grow with clinically-led commisssioning. PCTs have, in general and with some honourable exceptions, not yet proved themselves effective commissioners.

If GPs, obviously represented in bodies at a certain scale, are to drive the next stage of commissioning, including difficult and politically contentious decisions about reconfiguring acute services, they will have to manage competition and out inefficiency.

Where is the evidence that they will be any good at this?

Managing competition and outing inefficiency has not happened at scale, even in an NHS aspiring to 'world-class commissioning' and with a dedicated Co-operation and Competition Panel, as well as SHAs holding the ring (sounds uncomfortable, if not nuptial).

Managing competition was, admittedly, hampered by former health secretary Andy Burnham's "preferred provider" cat among the pigeons.

But then, managing competition is difficult. Adam Smith pointed out in Wealth Of Nations that "people of the same trade seldom meet together ... but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices".

A system which relies on the Dr Megsons of this world to do the right thing is going to have some awful failures where such principled people are absent.