Good morning, and an equitably excellent liberated day to you.

One benefit of the recent spike in Health Policy Insight’s readership has been receiving more emails from front-line staff concerned in how policy redisorganisation will affect their lives at the sharp end. That is the sharp end not as in budget meetings, but as in delivering patient care.

A new reader rose to the challenge of contributing a piece to Health Policy Insight. This clinician, from an NHS trust north of London, wrote to express their stupefaction about how the rhetoric of the White Paper will translate into front-line reality.

Without further ado, HPI presents for your edification the first HPI column from 'Doctor X'.

Ten reasons why the White Paper will all end in tears

by Doctor X

For some reason, in childhood days, you used to hear the phrase ‘Don’t come crying to me when it all ends in tears’. Could anything make less sense?

Well, the Coalition government and Health Secretary Andrew Lansley have managed to do so. Congratulations to them.

In a White Paper of eye-watering stupidity, they propose ‘Equity And Excellence’ – as if the two concepts were not practically and statistically mutually incompatible.

It’ll all end in tears (or in true NHS acronymophile fashion, IAEIT) for the following ten reasons:

1. GP consortia will have to propose and support in public hospital ward closures and decommisioning of services. There is just a possibility that they will not want to handle the opprobrium that comes with this. It’ll All End In Tears.

2. No one successfully tries to make GPs do anything. As anyone who has negotiated with the British Medical Association will confirm. IAEIT.

3. Foundation hospitals will outmanoeuvre the GP consortia in contract negotiations. As they did PCTs. If consortia find clever people from somewhere, FTs will simply do the Chelski / Man U thing and buy them. IAEIT.

4. The DH will quickly regret losing control of the NHS. David Nicholson is already firing off ‘Dear Comrade’ letters, emphasising how important it is that abolition-facing PCTs and SHAs hold the line. Stop sniggering. IAEIT.

5. The resulting postcode lottery of provision will get huge publicity. While people still have MPs to complain to, they will do so. PCTLand becomes an even more fun place to work as a result, which would previously have been hard to imagine. IAEIT.

6. The public will hear about the extra money the GPs are earning. Ker-ching! Or will all our dear primary care colleagues be doing it for the goodwill (hint-hint)? IAEIT.

7. Some GP consortia will overspend, and will have to be baled out. The NHS hasn’t got any money with which to do this (unless top-sliced budgets have such a big comeback that Liza Minelli looks like a rank amateur). And top-sliced bale-outs prevent people learning how to spend and manage money … IAEIT.

8. Some GP consortiums will go bust. Inevitably. With no risk to participants’ money. Why would they not? IAEIT.

9. Some acute providers will go bust and will close down. The Great British Public’s belief in the NHS is at least as much about buildings as it is about services. They will not like this. IAEIT.

10. The Secretary of State will have a row with Jeremy Paxman on Newsnight. Paxman will ask him the same question, again and again and again and again and again until SoS gets so bored, he actually answers it. IAEIT.

11. The newly-involved private health companies start to make record profits from commissioning. The business pages will notice, even if everybody else doesn’t. The Government will lose its case for a healthcare windfall tax. (Yes I know this is Number 11. Haven’t you heard about healthcare inflation? You must work for the DH.) IAEIT.

12. Some GP practices do the Grange Hill thing and ‘just say no’! Their populations will still need GP services. IAEIT.

13. Acute providers make hundreds of front-line staff redundant because of GP commissioning decisions. Unemployment, headlines, media, photo opportunities. IAEIT.

14. Waiting times get longer – a lot longer - and the press blame high-earning GPs whose trades union blame inadequate state funding to stuff their members’ mouths with gold. IAEIT.