Implementing commissioning policies to their fullest extent could introduce an era of integrated care organisations in England, spelling the end of traditional GP and consultant contracts, a debate heard this week.

Speakers at the debate, organised by the think tank Civitas, also warned consultants of a looming threat to their future employment because NHS foundation trusts will be looking to cut “unprofitable” services.

The debate—called “Commission impossible: is ‘world class’ commissioning achievable in the NHS?”—focused on the world class commissioning strategy published by the Department of Health last year, which set out the minimum standards that primary care trusts …