The Government has announced that the National Institute for Clinical Excellence (NICE) will no longer decide whether patients can have drugs their doctors prescribe. The quango will merely advise doctors on the clinical and cost effectiveness of drugs, leaving the final decision to doctors.This comes on the back of shifting commissioning powers in the NHS to GP practices. Both policies seem part of a coherent vision of a decentralised NHS where patients' 'care pathways' are monitored by the people they trust – GPs.

There are concerns over handing commissioning powers to GPs practices, which are unused to spending large amounts of money and unable to take account of aggregate needs. For example, carrying out blood or glucose testing needs large numbers to make tests economically viable, which is why these procedures are organised by Primary Care Trusts (PCTs) and carried out in large hospitals.

The idea of GP commissioning is that practices are close to patients and therefore best placed to commission for them. This makes a lot of sense – GP practices can be the human face of a sometimes too bureaucratic system. However, gaining the benefits of decentralisation means counteracting its downsides.

Consequently the Government is encouraging GP commissioning consortia where 'lead GPs' co-ordinate colleagues' actions to avoid potential waste and mismanagement. GP consortia aim to give us the best of both worlds –local knowledge and innovation coupled with larger scale coordination and planning. Demos has published a pamphlet on Cumbria's GPs' commissioning consortium, where Paul Corrigan spells out some valuable lessons on managing transition to GP-led commissioning.

However, transferring decision-making on drug prescription from NICE to GPs will give unwanted responsibility to the latter. It is one thing wanting a human face that is directly answerable for your healthcare. It is another expecting that human face to decide which cancer drugs to dole out at high cost to the taxpayer. This will put GPs under immense pressure from individuals and large pharmaceutical companies alike. As one GP put it (according to the LRB blog): 'Kiss goodbye to the benefit of the Dr-Patient relationship and hello confrontation and bitterness.'

Coherent policy is great; one of the present NHS commissioning system's failures is the Frankenstein's-monster-composition of top-down targets, consumer choice, bureaucratic management and small-scale GP practices. So, hooray to GP-led commissioning through consortia (as long as it is carefully and gradually introduced). But taking the heat off NICE and putting it on to GPs? It would be better to let bureaucrats earn their salaries and take the flack for contentious decisions, keeping a smile on the human face of healthcare.

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