The government's reforms to the NHS in England have focused on strengthening the role of healthcare providers through the creation of NHS foundation trusts and the procurement of additional capacity from the independent sector. Much less attention has been given to the role of healthcare commissioners. New guidance from the Department of Health describes how commissioning will be developed and also gives an update on the progress of the whole NHS reform programme.

There will probably be up to 100 NHS foundation trusts in England by the end of 2007 compared with 40 today, further enabling “a decisive shift from top-down to bottom-up” and completing the job of strengthening the role of healthcare providers.1 In an important development, the update guidance trails the possibility that providers of community services may become foundation trusts. Community NHS foundation trusts would enable the services provided directly by primary care trusts to be run independently of their commissioning functions. Equally important is the proposal that NHS foundation trusts …