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Hello Kosta, I'm a bean counter. There've been a lot of articles about death by contract/ spreadsheet and how fragmented this is all getting. But where I do think CCGs can drive change is by deciding what you want to do, share or buy. It's been made very clear to me that had my team not been strong performers and got good relationships with GPs, we'd have been given our P45s. I read a marvellous description of monthly performance meetings being like Agincourt meets Ground Hog Day. It's great having GPs part of that now, because you can really challenge - and in many cases, they're your patients. So we work to you not to a policy document/ set of instructions. As for the scale of the savings, have a look at Nigel Edward's piece on emergency/ unscheduled care. My problem as a manager is not having the clinical vision/ understanding of what would work. If you and your colleagues tell me, then it's our job as bureaucrats to make it happen. I'm sure I'll get shot down for being simplistic and "glass half full" but I'm tired of the doom and gloom. I've decided to try and look on the bright side. It's either that or go mad!