The UK NHS, particularly the NHS in England, has been subjected to continuous 're-disorganizations' over recent decades, amidst policy makers' seemingly unflinching optimism that changing NHS structures will improve process and outcome. In 1991, an 'internal market' was created by a Conservative administration. This model, widely emulated, separated publically funded purchasing health authorities from mostly public sector providers. They also created general practice (GP) fundholding, where some GPs took some of the commissioning role. NHS hospitals were offered 'Trust' status, with greater autonomy from central government. From 1997 onwards, a Labour administration repudiated but then re-invented the market reforms. Internal markets remained, but funding organizations changed into, initially, more than 400 geographically based Primary Care Groups, led by GPs. These merged into 152 Primary Care Trusts (PCTs), led by managers not clinicians. Labour developed Hospital Trusts into Foundation Trusts, given more autonomy but regulated by a national agency called Monitor. GP fundholders were abolished but gradually and partially reinvented as larger commissioning groups. Structural changes were accompanied by increased national regulation. Concerns about the safety and quality of care led to creation of the Care Quality Commission (CQC), which sets and enforces quality standards, licensing public and private providers of health and social care, and monitoring performance. The National Institute for Health and Clinical Excellence (NICE) was also created, to appraise new technologies and make reimbursement recommendations, and to produce guidance on healthcare and public health. In July 2010, a coalition government of Conservatives and Liberal Democrats published a white paper,[1] a statement of intention to legislate, proposing more change in the organizational structures of the English NHS. The new Government plans to rapidly and radically cut the fiscal deficit and the role of government in the economy. Pledged real increases in the NHS budget will be at best modest, despite continuing demand pressures of changing demography, technology and expectations. NHS expenditure control therefore remains a key policy objective. The Government has re-emphasized the principle that the NHS is 'available to all, free at the point of use and based on clinical need, not the ability to pay',[1] so the equity objective, at least in access to healthcare, also remains. But, like other recent reforms, the latest policies aim largely to improve efficiency of healthcare. The planned reforms emphasize choice, commissioning and healthcare outcomes. The Coalition proposes to abolish PCTs, current commissioners of healthcare, and replace them with GP consortia. These will be allocated budgets to commission care from competing public and private providers, and an unspecified 'management fee' to support this. There is debate about whether PCT staff will migrate to these organizations with little real change in management practice, or whether independent sector companies may enter this market and begin to influence the NHS purchasing function.[2-4] The Government plans to transform all English NHS hospitals into Foundation Trusts, either by mergers or by improved performance of current institutions. It anticipates that many Foundation Trusts will develop into 'social enterprises', autonomous institutions led by their staff, trading on a non-profit-making basis. The Government is also reforming the national organizational structure, establishing an NHS Board to set national commissioning targets. The current regional structure of ten Strategic Health Authorities will be reduced to four regional offices of the NHS Board. Regulation of the market is amended slightly, with the CQC continuing to license and scrutinize the performance of providers, and enhanced powers given to Monitor to ensure competition between public and private providers. …