BMJ  2007;334:1024 (19 May), doi:10.1136/bmj.39215.853206.BE

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Are plans to introduce practice based commissioning a shambles?

London

The government says that practice based commissioning offers potential benefits for patients and doctors alike, and GPs seem keen to explore the possibilities, so why does it feel like the engine won't start? Zosia Kmietowicz investigates

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

On paper the idea of practice based commissioning, a major plank of the government's modernisation programme for the NHS in England, seems to be a remarkably simple proposal, with few risks and potentially many gains.

The theory is that if general practices are given control of their own budgets for commissioning secondary care and community health services, the number of referrals to hospitals will fall, cutting hospitals' running costs along the way. With greater autonomy, GPs will also gain the freedom to exercise their entrepreneurial and clinical skills for the good of their patients by developing community services according to local needs.

And by providing expert care closer to patients' homes through "super clinics" in the community, GPs get to keep patients within their sights, delivering true follow-up of care and reaping professional fulfilment.

So what could possibly go so wrong? Why did Hamish Meldrum, chairman of the BMA's General . . . [Full text of this article]

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