Brinkmanship at the NHS

I've been discussing Clinical Commissioning Groups and the various twists and turns for some time - there's no denying they're turning into one of those procurement case studies which just keep on giving.

A very quick summary:

1. In 2004 the government negotiated, what is widely viewed as, a bad deal with GPs. The GPs got more money and were able to opt out of providing an 'out of hours' service.
2. GPs involved with CCGs expressed concern that they lacked the skills to handle the procurement aspects for CCGs.
3. NHS Guidance on procurement appears flawed and has to be rewritten just as it is required.
4. CCGs are identified as having clear conflicts of interest within procurement.
5. Demand on A&Es increases as a result of the systemic displacement from GPs opting out of providing 'out of hours' services.
6. GPs say patient care is suffering through the need to be involved in CCGs.
7. GPs are viewed as 'badies' and ministers hope to renegotiate the 2004 contract.   
8.  GPs trade union are threatening a withdrawal of the NHS' flagship Clinical Commissioning Groups. 

I'm sure there's no suggestion that GPs have less to gain through CCGs since the conflicts of interests were highlighted. Nor, I'm sure, is there any connection between the suggestion that the GPs contracts should be renegotiated by ministers and at the same time CCGs are precious to ministerial aspirations for the reform of the NHS.

You could of course view the whole thing as a shambles. But then again you could say it's just brinkmanship. It does have the appearance that one side is better at negotiation than the other though.