The doctor leading Cornwall's health revolution has warned of difficult choices ahead as the local NHS "cannot afford to do everything for everyone".
Kernow Clinical Commissioning Group (CCG) won approval earlier this week, with conditions, to take over buying healthcare on behalf of patients from April.
The new group, part of a controversial raft of NHS reforms, will for the first time see GPs taking a leading role in commissioning health services.
Its chairman, St Ives GP Colin Philip, said it was good news for patients in Cornwall, with quality and integration at the forefront of decisions.
However, he said a tight control would have to be kept on finances – and that all patients should be involved.
"We have to start to have discussions about the practicalities of an increasingly difficult financial world the NHS is in," he said.
"We need to have the ability to have that discussion because we cannot afford to do everything for everybody.
"How do we set these priorities?
"We have to look at the whole community and I think the best way is to involve patients right from the onset."
Kernow CCG will take over from NHS Cornwall and Isles of Scilly, the primary care trust (PCT), from April 1.
The budget for the new organisation is £760 million, some distance short of the £900million plus that the PCT currently has.
Dr Philip said the Kernow CCG would not have as broad a remit as the PCT – for example, purchasing of GPs, pharmacists and dental services, will be done by a new national commissioning group via a local team based across Devon and Cornwall.
This overcomes one of the initial criticism of CCGs in general, that GPs would be essentially commissioning their own service.
Family doctors do play a central role in the CCG, said Dr Philip, but he added: "We do not do the business side. There are better people than us to do that.
"This is an amalgam of clinical skills and business skills."
He added that the central difference between the PCT and the CCG was that clinicians would be at the heart of the new organisation.
"The difference is the clinical presence," he said.
"There was (clinical presence) in the PCT but that wasn't the principal driver.
"The governing body has six GPs, an independent doctor and an independent nurse, as well as lay members and patient advocates."
Dr Philip said the passion and pride many in Cornwall felt about their health service was an asset to the CCG.
"This is a public health service. It is not mine and it's not the Government's. It is all of ours and we all have a part to play in it."