THEY are arguably the most significant reforms in the history of the NHS, but as GPs take over designing local health services from today (Monday), few understand what the changes will mean.
This is the verdict of two leading figures responsible for making health decisions, past and present, for Croydon.
Currently procurement of health services is the responsibility of primary care trusts (PCTs) such as NHS Croydon.
PCTs will be replaced by GP-led clinical commissioning groups (CCGs) who will be responsible for 60 per cent of the NHS budget.
Croydon CCG, made up of all 61 of the borough's GP practices, will decide whether to pay hospitals to provide services, from urgent and emergency care to mental health and rehabilitation.
Toni Letts, former chairman of NHS Croydon, has been involved in establishing the new system. She said: "Most people will know that something is happening but do they know exactly what? No.
"I'm afraid the focus has been very much on closing down an organisation, which is quite sad and painful, but something good will rise from it.
"So if people are looking for balloons at surgeries saying 'We're part of the GP commissioning group' or 'We're now commissioning services for you', that's not going to happen. There's no big bang or launch.
"Things will seem very much the same, only they will get better."
The reforms met widespread political and professional opposition when they were finally passed last year.
Ministers argue GPs are better placed to respond to patients' needs because they are in regular contact with them, and say this will improve the quality of care, while critics describe the reforms as "privatisation by stealth".
There appears to be a lack of knowledge among patients as to what it all means, in part due to a lack of public engagement. Fewer than 30 people attended Croydon CCG's first open board meeting last September, and attendance has since dwindled even further.
"At the first meeting held in public there were around 20 people, which was wonderful," said Mrs Letts.
"At subsequent meetings there has not been that sort of number, but there were a lot more than we used to get for the PCT meetings.
"One of the things I suggested was that there should be mugshots of the CCG board member at every GP practice, so that everyone knows who they are.
"There should also be a newsletter about what was decided at the last board meeting and when the next one is.
"There needs to be an information flow between the commissioning groups and the patients but I've not seen that, have you?"
Local authorities will be responsible for public health from April. Croydon Council has been allocated £18.32 million which it will use to tackle issues such as obesity and sexual health.
"I hope people are aware, though whether they fully understand the changes is a bit of a sweeping statement," said Margaret Mead, cabinet member for adult services and health.
"We have tried to publicise it as much as possible. There have been public shadow health and wellbeing board meetings, various papers published, and I have spoken about it in my bulletin.
"There's always more than we can do. Healthwatch (a patients' group) is involved and they will be engaging with the public about services and their needs."