A third of senior health service managers think they will no longer work for the NHS in two years.

So what? The government has declared it wants to cut administration costs by a third. It looks like that reduction has been accepted by managers. But the government should be careful of getting what it wishes for.

Why? Consider the challenges facing the revolution in commissioning. The health secretary has said GP consortia will be free to draw support from PCTs. But shedding staff as quickly as possible runs the risk of leaving the cupboard empty when hungry GPs come looking for help.

GP consortia will need to build management infrastructure. Finding a way to retain the best managerial talent in PCTs during the transition phase and then transferring it appropriately into the new commissioning vehicles would maximise efficiency. It would also ensure some kind of corporate commissioning memory, preventing the new organisations from making a standing start.

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