“A poisoned chalice or the best thing since sliced bread?” The question posed by the GP showed serious symptoms of ‘cliche-itis’, but you had to admit (to use another hackneyed phrase) that he had certainly hit the nail on the head.

He was one of many doctors taking part in an online debate on the Government proposals to shake up the health service by handing important new responsibilities to GPs.

And, like most of the other doctors, this contributor recognised the enormity of what was being proposed, while being far from certain where it is all going to lead.

NHS Oxfordshire, as the local primary care trust confusingly chose to call itself only a short time ago (aren’t the county’s hospitals also part of the NHS in Oxfordshire?), will be swept away under the coalition’s reorganisation in 2012-13.

The Thames Valley Strategic Health Authority will also be abolished, leaving the once-humble GPs the people in charge of healthcare commissioning, free at last to buy the healthcare required for their patients.

Just as many patients cannot decide whether this marks a welcoming handing over of power from bureaucrats to clinicians or the dismantling of the NHS as we know it, the majority of doctors are unsure what they are faced with.

Is this a once-in-a-lifetime opportunity that puts them at the heart of decision-making in the NHS?

Or is it a wheeze to lumber them with managerial responsibilities for which they are not qualified, and ultimately turn them into scapegoats when tough decisions affecting their patients have to be made in a climate of under-funding?

We can be pretty sure about the level of GP uncertainty because Dr Tim Ringrose tells us that is the case.

Dr Ringrose can be counted as a man with a finger on the pulse of GP opinion given that he is medical director of doctors.net.uk, the UK’s largest and most active network of medical professionals, with more than 170,000 members.

Little wonder that when we met at the company’s headquarters at Milton Park, near Abingdon, he was preparing to head for London for a meeting with a senior civil servant in the Department of Health, keen to hear his advice about how best to communicate with doctors.

The findings of recent surveys by doctors.net.uk will not greatly reassure the department. Only a third of the network’s members thought the shake-up was a good thing, while only one in five believes that they are equipped to take over the role of commissioners of healthcare.

“Feelings are definitely mixed,” said Dr Ringrose. “It is going to be hard to have a major reorganisation like this at a time of belt-tightening.

“But, nevertheless, many doctors like the concept. Over the past decades they felt that they have not been consulted enough about how the NHS should be organised and the commissioning of services. This is the first time a Health Secretary has recognised that GPs are in the best position to make decisions.”

However, both patients and GPs have good reason to wonder whether doctors will have the same amount of time to see patients if they have to shoulder responsibility for buying most of the healthcare required for them.

“It is a big task, and some doctors are worrying about how the heck they are going to do it. Most GPs chose medicine in order to see the patients standing in front of them every day,” said Dr Ringrose.

“They will certainly not want to take time out from seeing patients. They have studied medicine. Most doctors have not taken degrees in business studies and management.”

In the new-look NHS, GPs have been told that they will be required to become members of a consortium, which would take over from PCTs to commission care.

But the Government has now made clear that GPs will not have to do the work themselves — they will be able to outsource it to other people or private companies. This has already led to speculation about the prospect of former primary care trust employees, having received redundancy settlements, being taken on by GPs to do their old jobs.

Others warn of American companies moving in to take on the job of deciding how billions of pounds of NHS funding should be spent, making millions for themselves in the process, in what would amount to the privatisation of the NHS.

True, an NHS commissioning board will commission services such as dentistry, maternity services and some specialised services, but consortia of GP practices will commission the vast majority of NHS services on behalf of their patients, including hospital care, rehabilitative care, emergency care and most community health services.

Abingdon GP Dr Prit Buttar said: “A little bit more flesh has been put on the bone. But it is still minimal. At this stage it would be premature to say whether this is something we should support or oppose.

“But it would be seen as contradictory for GPs to say they want no part of it, after previously complaining about the mess managers have been making of the NHS.”

It is impossible at this stage to even know whether Oxfordshire would end up with one large consortium, which some might see as replicating the present system, three consortia (one for the south, one for the north and a city consortium) or numerous consortia representing small groups of GPs.

Ask the Government how many of these consortia there will be and they will tell you that they should be formed on “a bottom-up basis” — in other words, it is for local GPs to decide.

But it does insist that they will need to have “sufficient geographic focus to be able to monitor contracts for locality-based services”. More ominously, it adds “the consortia will also need to be of sufficient size to manage financial risk effectively”.

“The smaller the consortia, the greater the risk,” warns Dr Buttar. GPs in small consortia could face serious budgetary problems if they are unlucky enough to have a large number of patients suffering from serious and ongoing complicated illnesses.

He discounts the idea that GPs could ultimately exercise a right to choose their patients in the interest of saving money on commissioning services, as some fear.

Doctors would view such a course as immoral, he argues.

But he believes they would quickly recognise that the only way to spread the risk and ensure financial feasibility would be to sign up for larger consortia, with some management experts claiming each consortium would need to cover anything from 120,000 to 400,000 people.

This would enable budgets to be estimated with greater accuracy, with the kinds of treatment required by patients averaged out.

The new system could also compound the problem of postcode lottery determining who receives costly drugs for, say, cancer, with some consortia prepared to pay for certain expensive treatments, but not others.

Localism, and giving our GPs a greater say in how the money is spent, may be popular with the public — but perhaps only until they realise that it will mean postcode lottery being taken to a new level.

Doctors are only too aware that the finger of blame would be pointed at them in the future when patients complain of being denied treatments for reasons of cost.

And having seen the massive deficits repeatedly run up by Oxfordshire Primary Care Trust, no one will be underestimating the challenge of trying to balance the books.

News of the coalition’s plans took everyone at the Oxfordshire PCT by surprise, including the new chief executive, Sonia Mills, who only took up her post in the spring, and now finds the organisation she came in to head is to be scrapped.

“It came as a complete surprise because the coalition had earlier indicated that it wanted people from local authorities appointed to the PCT board. So we were surprised to find that they had changed their minds.”

The day after news of the White Paper, she spoke to staff at the PCT’s base on the Oxford Business Park.

“Yes there was shock. People were worried about their jobs. Now people have had more time to think about it, they are beginning to see that some of our functions will remain.”

The commissioning arm of the PCT provides about 350 jobs.

Other areas of the PCT’s work — providing work for some 2,000 — are being hived off, with managers and front-line staff previously employed by the PCT now working for other organisations.

Community services, district nursing, children’s health and community hospitals are among the services to be taken over in April by Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust (OBMH).

Many of the PCT’s public health functions will go to Oxfordshire County Council.

The new chief executive is already faced with reducing the PCT’s management costs by 40 per cent over the next three years, as well as making general savings of £220m.

She believes it would be a mistake to underestimate the skill of private American companies with decades of experience, but maintains many of her staff will find a place in the coalition’s brave new NHS.

“The relationship between the PCT and local GPs is strong. GPs recognise the skills of people here and will not want to lose them. Doctors recognise the opportunities ahead, but also the time constraints and the risks, if they do not have the right support.”

She said efforts would be made to draw up transition plans to ensure vast amounts of money did not have to be spent on redundancy settlements for those who remained in the new-look health service.

And she points to the fact that seven consortia already exist in Oxfordshire, where GPs work together to extend services to patients, reduce unnecessary hospital referrals and, yes, manage more of their own budgets.

What is being proposed, however, is on a totally different scale.

She believes the county could end up with a federal system, with GP consortia across the county, but “a super consortium” negotiating on their behalf with the Oxford Radcliffe Hospitals NHS Trust, which runs the county’s three major hospitals.

“For patients, I think it will mean services will be made more local and more accessible,” she said.

But, like everyone else, the chief executive of NHS Oxfordshire does not know how things will turn out. It all amounts to a massive risk for the Government, GPs and everyone who uses the NHS.