An editorial in the BMJ a year ago asked whether practice based commissioning was “the sick man of the NHS reforms.”1 Practice based commissioning has been a central part of the government’s health policy since April 2005, when interested practices were first entitled to indicative budgets. The paucity of achievements described in a recent assessment by the King’s Fund suggests that the health of this patient is little improved.2 The government has recently clarified its vision for practice based commissioning, but will this be enough to deal with its persistent weaknesses?3

Commissioning is a mechanism for managing financial risk while matching services supplied to patients needs (or demands) in a quasi-market where patients do not pay for services directly. However, nearly two decades of experimentation in the English NHS have provided little evidence that any form of commissioning has greatly affected hospital services. Commissioning led by primary care has delivered some benefits in primary and intermediate care and some improvements in the responsiveness …