The decision by the Department of Health to open up the purchasing of NHS care, as well as its provision, to the private sector amounts to the last brick in the wall in the government's construction of the new-look health service.

To patients, such a move will make no immediate difference. They will still visit their GP and, if need be, move on for treatment, still free at the point of use, to the hospital or community services that are paid for by their primary care trust.