Truth! Understanding! The end of entropy! And babes!

I was pretty puzzled when David Cameron's plan came out to reform the NHS by making general practitioners responsible for all contracting for services.  It was vaguely in the spirit of primary-care-centeredness that led to the current Primary Care Trust system, and possibly GPs are better respected in the UK than bureaucrats and hospital administrators, but the glaring issue was, "Why would GPs be particularly good at managing this huge administrative burden?  Why would they even want to take it on?"  I thought it most likely that, if it was passed as advertised, GPs would collectively delegate their new responsibilities to some body that would become yet another bureaucratic overlay on the same system as before - much like the Primary Care Trusts.

Well, the picture is becoming more clear.  Polly Toynbee writing in the Guardian to interpret a new article by Cameron in the Telegraph:

Every single public service will be put out to tender. Everything. ...Forget the camouflage of localism and choice: however much local people like local services that work well, they will have no choice in the matter. .... 

Democracy will scarcely get a look in. People can't choose if services are contracted out. Once contracts are signed, nothing can change. You can throw out rascally councillors or governments, but the contracts will go on regardless. Like PFIs, they will be traded as financial instruments, sliced and diced according to risk and sold on. This sets a nuclear bomb under all public services, because there can never be any going back. If you don't like the sound of this, Cameron's government can be voted out but it will be virtually impossible to return services to a public realm that no longer exists. Ownership of the contracts and companies moves on, and the public sector loses any capacity to take them back. 

Apparently this is very similar to what's happened with public-private partnerships over the years.  It seems all too likely that this is how it could work out in practice, and that the conscious goals are the accumulation of private profits and the sapping of public capacity.

This is one of the most creative policy innovations I've heard about in some time, and not in a good way.