Analysis

GP led commissioning: time for a cool appraisal

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e980 (Published 16 February 2012) Cite this as: BMJ 2012;344:e980
  1. Judith A Smith, head of policy1,
  2. Nicholas Mays, professor of health policy2
  1. 1Nuffield Trust, London W1G 7LP, UK
  2. 2London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, UK
  1. Correspondence to: J A Smith judith.smith{at}nuffieldtrust.org.uk
  • Accepted 24 January 2012

The government has identified GP led commissioning as critical to tackling the twin challenges of service change and improved efficiency, but does the evidence bear this out? Judith Smith and Nicholas Mays investigate

General practitioner led commissioning is a policy with which the English NHS has held faith since 1991. The establishment of over 250 clinical commissioning groups comprised primarily of general practitioners (GPs) represents a central plank in the English NHS reform programme currently being debated in parliament.1 It is proposed that from 2013, commissioning groups will gradually assume responsibility for £60bn (€72bn; $95bn) of funding from primary care trusts when they are abolished and be accountable to a NHS Commissioning Board. We use the evidence on previous GP led commissioning initiatives to highlight the likely limitations of new commissioning groups and suggest some changes.

What is GP commissioning meant to solve?

The perpetual desire to strengthen commissioning reflects frustration at the seeming failure of different purchasing arrangements to shift care from hospital to community settings and reduce the rates of avoidable emergency admissions.2 Instead the NHS has seen an inexorable rise in emergency admissions over the past decade3 and an expansion of secondary care spending and activity.4

The desire to halt this trend and develop alternative forms of care, especially for frail older people with complex conditions, is now stronger than ever. The NHS faces an unprecedented 4% efficiency target for each year until 2015. GP led commissioning is a key part of government plans to meet these challenges.

What is the rationale?

The rationale for GP led commissioning is that GPs, given their gatekeeping role in relation to expensive secondary care and diagnostics and knowledge of patients on their practice lists, are well placed to purchase health services on behalf of the local population. They are considered to combine an individual patient focus with …

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