Opinion  

His speech at last year's Labour party conference was hailed a resounding success and he seemed certain to win if he called the snap election so many predicted he would.

Fast forward 12 months, and how things have changed. Labour is languishing in the polls, with public support in freefall. Many pundits predict that the knives will be out for Mr Brown at this year's conference, while other prominent figures will be jostling to position themselves as credible successors.

A year is a long time in politics, which explains why successive governments, particularly those facing troubled times, are so desperate to push through changes and reforms at a rapid rate.

One example is the introduction of GP-led health centres. Health minister Lord Ara Darzi first announced that 150 centres would be established in October 2007. PCTs were later told that these must be open by March 2009.

This does not give PCTs long to consult with local communities, find premises, undertake any necessary building work or adaptations, complete the tendering process and make sure that the centres work effectively with existing local services.

And it seems that this ambitious time scale might be causing some problems. The speed with which the centres need to be set up means PCTs have no time to acquire new land near transport hubs, or build shiny new premises. Instead many are relying on existing buildings.

This somewhat restricts options for where the centres can be located. Reports from across England suggest that several may not be located in the most accessible areas within their PCT, which reduces the number of people who can use them.

There are also suggestions that many may not be located in trusts' 'under-doctored' areas, because there are no sites available. This makes it likely that they will end up competing with existing practices and has huge implications. Practices could find their business threatened simply because of where they are located - and by a new health centre that many patients may not even want.

The huge number of signatures the BMA's 'Support your surgery' campaign garnered suggests that patients don't react well when their local practice is under threat and that they don't like the idea of private companies providing local health services.

In its push for a quick win that will go down well with voters, the government has failed to think through the consequences of this plan and it may well find it scores an own goal.