Regular readers will recognise that one of the themes of this blog over the last 9 months has been how, despite the heady intentions of the Secretary of State in July 2010 to localise power in the NHS, recent practice in setting up the reforms has been to give ever greater power to the centre – in the shape of the National Commissioning Board.

My recent experience within the reform programme of the NHS has underlined the impact this is having on local experience. Just in the last few weeks a number of GP leaders of local commissioning groups have expressed surprise at how they are being treated by the local arms of the NCB (in the shape of clustered PCTs and SHAs). They are being told to come to meetings at a few hours notice; to change their plans at a weekend’s notice and generally getting a good introduction to the centrist culture of the NHS. Up until now most GPs have avoided this experience because the NHS centre has not seen them as being sufficiently powerful to bother with.