Intended for healthcare professionals


Reinventing clinical commissioning groups

BMJ 2013; 347 doi: (Published 09 August 2013) Cite this as: BMJ 2013;347:f4980
  1. Kieran Walshe, professor of health policy and management
  1. 1Manchester Business School, Manchester M15 6PB, UK
  1. kieran.walshe{at}

They should leave commissioning to NHS England and focus on improving primary care

The new organisational architecture of the NHS in England makes little sense to most of the people who have to make it work. Even the usually po-faced King’s Fund has mocked the Byzantine complexity produced by Lansley’s health reforms with its “alternative guide” to the new structure of the NHS, replete with a Heath Robinson-esque cartoon of the system.1

Having set out to liberate and simplify the NHS,2 the government has ended up with more organisations and more complex interorganisational associations, while, paradoxically, no one seems to be in charge at a local level. It has also increased centralisation through powerful new national entities like NHS England, Public Health England, and Health Education England. Yet after the traumas of the past three years,3 there is little or no appetite for further organisational change, so policymakers and NHS leaders must find ways to work within these new …

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