Well, it's begun.

There is a moving scene in Britten's opera Peter Grimes, where Peter's lady friend (Ellen Orford) is looking after his apprentice, and they are sitting outside of the church on sunday, and Ellen is trying to engage in talk with the boy. She knows about Peter's violent and rough ways, and hopes to change him. She notices a bruise on the boy's neck, and realises that Peter is returning to his old brutal ways of hitting his apprentice.

She sings poignantly "Well, it's begun"

Peter Grimes is a terrific opera, and always has an effect on Jobbing Doctor.

I was reminded of this moment when I read a report from a management consultancy firm who are recommending that GPs cut referrals, or else. This has been made by a firm called Tribal who are close to the centre of Government policy. Cut spending on referrals, they say.

Well, it's begun.

I don't refer people without good reason. I refer them because they need referral. The patients might request it. The family might request it. It might be to get an expert opinion, or get something done. I don't refer for the fun of it, and I object to some spotty management consultant telling me what to do: I do what the patient or I feel is best.

There is an arrogance in these pronouncements. It is as if they know what they are doing. They know as much about General Practice as Lord Darzi does (which is virtually nothing) or as the authorities knew about Stafford Hospital

We (the taxpayers) are paying £350,000,000 per year for the advice of people like Tribal. You might not be surprised that Jobbing Doctor can see straightaway where £350 million pounds could be saved.