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?"
Dr Agnelo Fernandes, Croydon CCG's assistant clinical chairman, says patients will see the benefits in the years ahead.
"This is a challenging but exciting time for the NHS and its staff and we have been working hard over the past 12 months to make sure the move from the old NHS structure is as smooth as possible.
The reason for this hard work is so that, in the short term, local people don't notice any difference in the day to day care they get from their local NHS; on the frontline it's business as usual.
"It's over time, though, that the benefits of having local GPs making the decisions will really start to be felt.
"Croydon GPs know their patients and know what their needs are - we see them every day in our surgeries."
Croydon CCG faces major financial hurdles to achieving goals such as reducing the number of patients who attend Croydon University Hospital's accident and emergency unit.
It has been left a legacy of debt at a result of NHS Croydon's £28 million overspend.
"We have a significant financial challenge and we need to continually improve the quality and reputation of healthcare in Croydon," added Dr Fernandes.
"What stays the same is how closely we work as one NHS, in partnership with other neighbourhing CCGs, Croydon Council and the local hospitals.
"We are determined to make sure we deliver the best healthcare for the people we serve."
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."
