Commissioning perhaps shouldn't follow the American way

doi:10.1136/bmj.331.7530.1473-b

BMJ 2005;331:1473 (17 December), doi:10.1136/bmj.331.7530.1473-b

Letter

Commissioning perhaps shouldn't follow the American way

The first 150 words of the full text of this article appear below.

EDITOR—Donaldson and Ruta make a compelling case for theadaptation, rather than replication, of US health systems inEngland.¹ That general practices should increase in size tomanage populations of 25 000-30 000 makes organisational andeconomic sense, and those practices that achieve this will,no doubt, be the survivors in the world of contestability usheredin by the forthcoming white paper on care outside hospitals.

However, this suggestion deals only with the provider side ofprimary care. For the purposes of commissioning, whether basedat the level of the practice or primary care trust, populationsof 30 000 are almost certainly too small. This size of patientbase exhibits too many variations in referral rates and secondarycare activity to accommodate commissioning budgets safely, andthese "super practices," if contracting in secondary care professionals,risk fragmentation and unsustainability of the secondary caresector.

The government's move towards . . . [Full text of this article]

John Hughes, clinical director

South East Hants Primary Care Trust Cluster, Waterlooville, Hampshire PO7 7GP jrhughes@nildram.co.uk