This element of the Darzi approach does seem top down at a time when local needs assessments are said to be the drivers.
The King's Fund states that there is no evidence that larger groups deliver better care than smaller ones so big is not inherently better (GP, 6 June 2008).
It seems much more sensible to at least look at local NHS talent for service provision and empower its natural development - provided the public supports it.
Suffolk is a rural county that does not have the health deprivation of much of the nation but it does have dedicated NHS staff who want to do more.
In Saxmundham, midwives perform the national record of home births (13 per cent) because their patients ask for it. They could do even more with a birth centre which could generate NHS income.
A one-stop-shop location halfway between two hospitals at the only deprived practice within 25 miles has some logic but when this is combined with 520 letters of support at the planning process it seems to have both strategic and local approval.
Why do NHS staff who know what their patients want just get stick from behind and tight bit for direction in front? If the reins were slackened then we could make real quality and choice progress - in the right direction.
Dr John Havard, Saxmundham, Suffolk