GP led commissioning: time for a cool appraisal

Many innocent years ago I was Chair and clinical lead of one of the first 4 national GP total purchasing pilots (Worth Valley Health Consortium). The consortium covered a discreet geographical area well served by an excellent district general hospital. As our experience in commissioning increased, long before any research was published into our progress, we realised that the budget boundaries between primary and secondary care were impeding any overall progress in improving efficiencies and outcomes for our local population.

Accordingly, approximately 15 years, ago my general manager and I approached the Department of Health offering a pilot horizontal integration of budgets across ourselves and our local secondary care provider. We saw this as the next logical step (and though we also had the grandiose idea of adding integration with social care we knew that was a step too far). We were gently told that our offer 'was not the direction of travel at the time'. If only the risk had been taken and we had been given the opportunity the NHS might be in a completely different place today!