Back to the future?

The NHS Improvement Plan and new Department of Health guidance sets out proposals to revive commissioning by individual general practices of health services in the NHS in England, as part of a commitment to explore and evaluate new models of devolved commissioning.1 2 From April next year, any general practice that so desires can obtain an indicative commissioning budget from their primary care trust.

We have been here before. For many people, practice based commissioning will seem to be simply general practice fundholding rebadged. The new proposals bear striking similarities to fundholding, sharing such characteristics as budget holding by general practices, commissioning freedoms for individual practices, and direct financial incentives for general practitioners. Fundholding was, perhaps, the most contested element of the NHS internal market setup by the last Conservative government and was opposed bitterly by the opposing Labour Party. The creation in 1999 of collective primary care commissioning through primary care groups (which evolved into primary care trusts) was proposed as an antidote to the perceived drawbacks of fundholding, in particular, inequities …