The English public wants three things from community services: to have more control of their health and care; support and enablement to maintain their health, independence, and wellbeing; and rapid and convenient access to high quality, cost effective care, closer to their homes.1 2 Hence, in a white paper—Our Health, Our Care, Our Say: A New Direction for Community Services—earlier this year the Department of Health recommended a substantial transfer of NHS functions to the community, proposing that up to 15 million outpatient attendances should be delivered in community settings.1

To avoid fragmentation, control of most local health resources will be given to general practices via practice based commissioning while primary care trusts develop the necessary infrastructures to shift specialist care. Primary care trusts will be given the incentives for change through the mechanism of payment by results, a method already being used with hospital trusts to pay providers a fixed price for …