Changes that will lead to no changes

There is a lot of speculation about how many patients would be covered by each GP consortium. There has been general comments that it is infeasible for a consortium of less than 100,000 patient to do commissioning. England has a population of about 50 million and there are 150 or so PCTs so at the moment, on average each PCT covers about 330,000 people. So it is rather interesting that Healthcare Republic are reporting that the GPC is recommending that GP consortia should "federate" because they say that "consortia covering populations of less than 500,000 will struggle to manage risk". In other words there will be about 100 "federations" compared to the current 150 PCTs.

Can someone now explain why we need to go through the costly changes (that Lansley says will cost £1.7bn, and the Manchester Business School says could cost £3bn) when we will get essentially the same organisational structure?


UPDATE:
The former DoH commissioning chief Mark Britnell has said that GP consortia must be "at least the size of PCTs". While the chair of the RCGP, Professor Steve Field, said last month that just "a few expensive patients" could cause a small consortium to overspend.