Clinicians who are unsure about how the new NHS in England is going to work may not have been reassured by a seminar at the Royal College of Surgeons on 10 October. How will doctors commission care, and what evidence is there that they will do it any better than the managers they replace? Many concrete questions were raised, and many abstract answers given.

The doubts included the conflict between locally determined priorities and the national “offer” the NHS is supposed to provide, the complexity of the new structures, the apparently contradictory roles of the NHS Commissioning Board (charged with both cooperating with clinical commissioning groups (CCGs) and “performance managing” them) and the perennial difficulty of reconfiguring services. “Have faith” sums up the responses provided by representatives of the Commissioning Board and the NHS Trust Development Authority.

Charles Alessi, although a prominent supporter of clinical commissioning and interim chair of NHS Clinical Commissioners, was scarcely reassuring. He warned …