ABSTRACT
Historically major institutions along with the societies and states they represent must achieve a condition of homeostasis. The mode of control, as in eighteenth century Europe when the phrase ‘balance of power’ was coined may move from dictatorship to parliamentary sovereignty and back, but for the system to survive shifting power must lead to a new balance. The principle of primary care-led commissioning appears to be irrevocably established in practice, regardless of future changes in national administration, and its expression signifies not simply a new era of devolution for the National Health Service but the sanctioning of difference throughout the UK health care system. The chapter explores that best understood in behavioural terms as a political process that has deliberately destabilized the established order. Such behaviour is the stuff of revolutions and all revolutions have an end point which, viewed historically, are often abrupt and sudden.
