The complexities of how local NHS services are paid for and the rapidity of reforms may lead to the full significance of the changes now being pushed through being overlooked.

But for anyone who may have cause to use maternity or mental health services, or services for the frail and elderly, it would be wise to closely follow what is being proposed.

When it was announced in April that a new era in healthcare had begun for the local NHS, much of the focus was on the novel idea of GPs becoming responsible for buying hospital and community health services for local people.

But the huge demand for local services and the need to claw back millions from the county’s healthcare budget always meant that the new Clinical Commissioning Group — under the South Oxfordshire GP Stephen Richards — would not wait long to press ahead with a radical agenda.

Outcome-based commissioning is said to hold the key.

Put simply, this means that instead of paying hospitals and healthcare providers for activities such as operations, they will be paid for good outcomes, the quality of service and the things that matter to patients, say like an elderly patient being able to live at home independently. Failure to deliver would mean part of the payment being withdrawn.

The level of concern being expressed by the chief executives of Oxford University Hospitals NHS Trust and Oxford Health NHS Foundation Trust has rightly led to further pause for thought. Their letter of warning, while polite, is blunt.

There are real clinical risks and financial risks with pressing ahead with a radical and untried approach, they tell us.

The complexities of delivering services for the elderly, mentally ill and in maternity, is simply not being recognised, and, in their considered view, it would be impossible to deliver the new system by April 1.

Given that the chief executives will be providing much of the healthcare, their analysis is indeed worrying.

There is far too much at stake, for both patients and health workers, for this pioneering approach to be rushed into and found to be wanting.

There are also enormous implications for the viability of other hospital services and the finances of our hospitals.

There was certainly a strong case for trying it out in a limited area such as diabetes, before going for the costly, complex and risky areas chosen.

One way or another, outcome-based commissioning is on its way to Oxfordshire. But when it does come it would be comforting for patients and their families to know that the likes of Sir Jonathan Michael and Stuart Bell are right behind it as well.