In its recent report, the Audit Commission described the current state of implementation of practice based commissioning.1 The commission defined such commissioning as a way of managing financial risk as well as a means of improving services and use of resources. Under practice based commissioning, primary care trusts devolve indicative budgets to practices (practices do not receive the actual money, but operate within an agreed budget held and administered by the primary care trust) to give them financial incentives to manage referrals, and to commission and redesign services to make them more convenient, appropriate, and cost effective.

Practice based commissioning has been a central part of the government’s current reforms of the National Health Service (NHS) since April 2005, when interested practices were first entitled to an indicative budget. Any assessment of progress must therefore be of interest in assessing the fate of government health policy overall.

The Audit Commission studied the second year of practice based commissioning (2006-7) in 16 primary care trusts. The study was based on semi-structured interviews with trust staff, selected general practitioners, and selected practice managers, combined with a survey of …