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Commentators discuss Health Secretary Andrew Lansley's plansto abolish primary care trusts in England and hand budgets to GPs.

The it's unrealistic to put through reforms in a time of cuts:

"The Health Secretary has attempted to turn this objection on its head by saying that reform is necessary to deliver efficiencies. It is a heroic, but ultimately unconvincing argument. It is impossible to see new GPs' consortia delivering vast savings at the same time as they are hiring staff and getting to grips with their new responsibilities. Structural reforms always end up exceeding cost estimates, at least in the short term."

that such a big change wouldn't work:

"I'm totally in favour of making savings in the NHS and there are enormous savings to be made. I'm totally against another 'throw everything up in the air', reorganise it in an entirely different way, leave people feeling that they don't know where they are, have nothing to measure against because the whole system will have changed.
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"Good change is evolutionary. You work with what's there and you change it bit by bit.
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"This another of those political things where it's all very exciting, we're going to give the money to GPs, it will be a shambles for four or five years and by the time it's starting to work someone else comes along and wants to change it again."

a political reason for speedy reforms:

"As the Health Select Committee pointed out yesterday, securing efficiency gains of the kind required - 4 per cent a year over the next four years - has never been achieved by any health service anywhere in the world. Yet Mr Lansley expects the NHS to pull off this miracle while simultaneously achieving another - switching control of the bulk of the NHS budget from managers to GPs...
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"So why is Mr Lansley committed to the path of maximum disruption? Because he is determined not to repeat the 1997 Blair government's mistake by delaying reform and then finding there is too little time to implement unpopular changes before the next election."

The chief executive of the NHS Confederation that decentralisation could be worth the risks involved in change:

"There is no doubt that reforms on this scale, at this time, are hugely risky. NHS leaders around the country suggest a high level of anxiety about the implementation programme in particular, not least because of the tight NHS budget. Having said that, there is good evidence to suggest health systems work better where budgets and spending power are as close to patients as possible."

Conservative MP and former NHS doctor as long as choice is given to patients:

"The current proposals seem to be heading in the direction of large GP consortia, based on geographical area. This means that although a patient will technically have a choice of GP - and therefore their consortia - in reality all the practices in their area will part of the same consortium, so offering no real choice for patients. As the consortia are planned to be large, the link with patients will be more distant than in fund-holding times."

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