The future of locality commissioning

GP fundholding was introduced by the Conservative government to involve general practitioners in shaping local health services1: individual practices acted as agents for their patients, using their own budgets to bring about quality and efficiency improvements in hospital and community health services. A range of alternative, unofficial schemes has emerged at local level (non-fundholding, general practitioner led commissioning, and locality commissioning2 3 4) led by non-fundholders who want to help shape local health services but are sceptical about holding an individual practice budget. These schemes have received less attention than fundholding and its derivatives,5 6 but this issue of the BMJ includes a rare attempt to evaluate locality commissioning in Avon, where there seem to be modest benefits at a much lower cost than …