The process of change is a strange thing. “A change is as good as a rest,” they say, or “out with the old and in with the new!”, suggesting new is always better, faster, brighter, smarter. And I’m really starting to hate the expression “May you live in interesting times”, because people say it to mean “If you’re not panicking, you haven’t understood the situation!”.

Of course, we all know that public services can only ever improve, and new policies must always be an advancement, so a radical shake-up of the NHS was inevitable – after all, a new government can’t just put its feet up and say “If it ain’t broke, don’t fix it!”, so we have to have yet another white paper – this parliament’s attempt to reinvent the NHS wheel.

And I wish I could get excited, I really do, but I fear they’ve thrown the baby out with the bath water in the decision to do away with PCTs and SHAs because, however we felt about their varying engagement with pharmacy, they had the structure to stand up against the GP commissioning groups. Yet this white paper seems to be centred on GP consortia, when it is supposed to be centred on the patient (am I alone thinking “No decision about me without me” is a sound bite from a cheesy American self-help tape?).

Now let’s not confuse this with GP fundholding – that was just about manageable for the average surgery. No, this GP commissioning consortia is a much bigger fish and, without the sort of support staff in place to manage it all, I fear some consortia may bite off more than they can chew. Let’s not forget that there is a reason surgeries have a practice manager, and our nearest regularly assures me that “the kids” – as she calls them – couldn’t organise a chimps tea party. So what happens to local payments and services while our new masters find their way?

And to say patients will decide who provides their care just shows we have learnt nothing from Choose and Book, the attempt to push up secondary care standards through ‘market forces’. As patients we don’t want to choose – that’s why we’ve come to a healthcare professional to tell us where we should receive treatment – otherwise I’d be getting my appendectomy off eBay.

I also don’t want my GP to snatch my prescription back saying “I’m not only your doctor, I’ve commissioned myself to be your dispenser too!” But there won’t be a plurality of suppliers lined up to offer services, unless they have an expectation of sustainable business, so it’s all very well for everyone to say this is an exciting opportunity for pharmacy, but what about the opportunities of LPS and vascular screening and all the other exciting services that came and went?

This particular wheel just keeps going round, and I fear we may not learn from the past.