"The act of committing finite resources to evidence-based interventions, particularly but not limited to the health and social care sectors, with the aim of improving health, reducing inequalities and enhancing patient experience." (Michael Sobanja: What is world class commissioning? (May 2009).)

"Fundamental changes in the way services are commissioned are going to be required to achieve that level of savings. NHS organizations can't - and aren't - just looking at reducing their spending on stationery. Massive efficiencies are required across the board, from the ground up."

"The onus is on PCTs because they have been instructed to prepare a legacy document - basically a quasi-due diligence exercise. All their contracts, written down or not, are supposed to be catalogued."

"What are the terms, conditions, your rights and obligations? What is the duration of existing contracts? You need to make proper enquiries to ensure you understand where you are, then what you want to achieve, the options and the best route to get there. Understanding where you are will not just involve reading a pile of contracts - it's also likely to require detailed review of how the contracts have been run, which may involve trawling the hard drives to check emails, minutes of meetings, and so on. Then you need an action plan and timetable - what do you need to continue, renegotiate or re-procure? Are you better off abandoning a contract or consolidating it into another service?"

"CCGs are going to have something of a headache in taking over existing contracts if they are smaller than the PCTs. They're likely to have to form new collaborative arrangements to deal with the existing consortium agreements between PCTs, so there is just one contract for a huge hospital.

There's no formal requirement for that from the Bill, although I suspect the NHS Commissioning Board will ask difficult questions if they're not doing it. If they don't, you've got to break up existing contracts."

"It's not like other services where you can stop for a few days then start again. There are hundreds if not thousands of patients going through procedures and processes every day in most regions. Transition of commissioning - and the services beneath - has to be absolutely seamless, moving from one structure to the other without stopping."

"If you put commissioning in the hands of GPs with no training or support it would fall flat on its face - the NHS Commissioning Board will be making absolutely sure that groups have the support they need. CCGs will be under a statutory obligation to deliver continuous improvement in quality and outcomes."

"GP commissioners won't have specialist expertise when it comes to neurological services, being generalists. We might find similar specialist support developing in other areas like mental health."

"The most immediate practical impact of the enactment of the Bill will be that there is a risk of insufficiency of incumbent expertise in the application of procurement rules in the consortia and their governing bodies. The complexity of the regime and the administrative burden in complying with the rules (which are constantly evolving through a rapidly expanding body of case law) cannot be underestimated."

"The rules are very clear and bidders understand and are willing to use their rights much more. Many incumbents who are at risk of being kicked out take the view it's worth having a go - they've got little to lose. The same can go for new entrants. If they're breaking into a market and haven't had a great deal of success, they may challenge to find out why they've not been successful - and who has and why."

"Not that long ago NHS contracts were not enforceable within the NHS. Historically, having not been subject to legal challenge, most agreements were entered into without external legal advice. Culturally, there is a very different relationship between the NHS and its legal advisers compared to, say, local authorities. Local authorities have significant in house support, as well as external support from legal advisers.

But all that's changing. The NHS market is experiencing increased competition, and diversity in provision and procurement from organisations outside the NHS. Our clients are taking more advice from us on procurement and competition law than they were five years ago."

"The provider market is becoming increasingly inclined to challenge. On the other hand, expecting commissioners to go out and tender for your local acute services every year doesn't sound like a good use of money. The incumbent owns a hospital and it's difficult to see how anybody else would be in the market. Trying to fit the way the NHS is into a procurement regime does create difficulties."

"Lawyers will have to advise clients on the risk, but ultimately the client is going to have to form a view as to the extent they want to go to procurement. Is it constructive? Is it a service where realistically one can expect competition?"

"If you want to avoid dealing with a bloody 'divorce and Relate' situation, get your prenup agreement right. If you document and understand right at the beginning what you're procuring and what the service is going to look like - building in the legal, commercial and clinical aspect and taking account of the political aspects - you'll be in a much better position. If you haven't you can almost write the script as to how problems will arise."

"AQP, if it is to be delivered in strict compliance with procurement law, is likely to be established by a series of framework agreements. It's nothing we haven't seen before many times in comparable circumstances."

"Local authorities operate a not dissimilar system for care home placements. They will have their list of approved providers. When an individual needs to be referred to a care home they can choose off the list."

"This is an area that GPs understand well. It is likely the emerging CCGs will tackle this developing market with new and redesigned services. There are a lot of potential savings to be made and [the chance to] deliver improved outcomes for patients.

We have already seen diagnostic services moving away from acute hospitals into primary care settings, also treatment - Hospital at Home is an example. If the NHS is to be responsible for re-ablement services up to the first thirty days after discharge, there are opportunities for any qualified provider to come in and provide what is a new service.

We'll not see CCGs tendering services for acute hospital services, where competition will be difficult and where there is a risk of cherry picking leaving NHS hospitals potentially non-viable."

"The biggest problem is TUPE - if you've got an NHS provider currently providing the service, and a social enterprise looking to take it on, the workforce would be TUPE'd across with pension rights. The cost of that is a major inhibitor to diversifying the provider market.

That's why I think existing hospital services, especially large services will remain with NHS providers where it will be business as usual."

"I don't think the private sector see proposed changes in the law as an enabler for securing more NHS work - there is scepticism about the short term opportunities. But the Bill does create an environment where, over time, there will be increased opportunities to develop new services and run existing services."

"Especially in health services there are difficulties because the people involved in referrals, for example GPs, may have interests in the services being referred to. In extreme cases it can completely distort the market. This may need good controls and to be policed."

"A concern that has been raised in some quarters is that the private sector will cherry pick the profitable services and the NHS will be left with highly specialist high cost work which can be unprofitable. However, if the NHS and private sector work together, and commissioners procure sensibly, there are undoubtedly improvements in quality of care and value for money that can be achieved."

"It used to be the case that hospitals would say to the commissioners, 'this is how much money we need to stay in the black so we're going to provide all these services'. Hospitals were trying to sell what they made, rather than making what will sell. Most providers now recognize that they need to tailor the nature and scope of their services to what the commissioners need and be flexible, efficient and innovative in their delivery of these. If they don't, they won't survive."

"The idea is GPs will be negotiating contracts and might have more sway with providers. But whether a generalist sitting across a table from a heart surgeon will have equal sway is an issue."

"We'll see CCGs commissioning their own very local stuff for people with long term conditions, then collaborating across the system with other CCGs to do regional [hospital] commissioning."

"There's a significant policy imperative for getting health and social care - especially adult social care - working together through joint commissioning and the legal structures that are there already. But putting this into practice is often quite difficult and depends on goodwill at local level, plus a willingness to trust each other. There isn't anything within this Bill which makes integration easier to achieve."

"On the provision side we are going to see more section 75 type schemes, or even schemes set up outside that bit of the legislation. But on the commissioning side, the instability amongst health commissioners in terms of personnel means things will move more slowly over the next year to eighteen months. CCGs are feeling their way, and in PCTs people are still working out who has a job."

"[If so] there is a concern that local authorities may not be familiar with what public healthcare commissioners have been doing for a significant length time in this area. There's a real requirement for local authorities to get up to speed with that knowledge and much of the technical detail of what their health partners have been doing."