In the next two years, the NHS at the local level risks becoming a rudderless ship, with no single organisation in charge. PCTs are beginning to feel sidelined and disempowered, and a power vacuum is quickly developing.
There is widespread disillusionment within PCTs, and in some areas staff are leaving in droves. Although many PCTs are inefficient, not everyone in them is substandard. There is a definite risk that real skills will be lost to the NHS if the better-quality managers aren't quickly assured of a job in the new-style consortia.
Commissioning is another headache - in particular, the handover from PCTs to consortia. Life won't suddenly stop on 31 March, 2013, to restart on 1 April - nor will commissioning contracts. There has to be meticulous forward planning, and a seamless transfer. Consortia commissioners will need to shadow their PCT counterparts for some time before the handover date to ensure that new contracts which continue into the post-handover period fit in with their consortium's wishes.
These three problems - the power vacuum, the risk of skill loss and the need for transitional commissioning arrangements - mean that all consortia will need to be up and running well before the handover date.
Which leads to the last difficulty. Long before the go-live date, those GPs active in consortium management will need to spend a considerable amount of time preparing their consortium's structure, hiring its senior managers and developing its policy.
But they can't do this in their own time. Running a consortium isn't a hobby. During the transitional period consortia will need generous funding for locums and backfill to allow involved GPs to be released from their practices to attend regular meetings.
Good as they are, the White Paper's proposals won't work if the transitional arrangements aren't thought through properly, and adequately funded up-front. It can't be done on the cheap - indeed, catastrophe awaits if the transition is not properly planned and resourced.