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Feature Public Health

Blue sky commissioning

BMJ 2014; 348 doi: (Published 23 January 2014) Cite this as: BMJ 2014;348:g285
  1. Zosia Kmietowicz, assistant news editor
  1. 1BMJ, London WC1H 9JR, UK
  1. zkmietowicz{at}

Some of England’s commissioning groups are taking the lead and changing local health services for the better through link-ups with local government, Zosia Kmietowicz reports

Handing general practitioners in England the lion’s share of the NHS budget in April 2013 may have seemed a bit of a gamble. The challenges set by NHS England, established under the Health and Social Care Act, were tough—commission services that deliver quality improvements, better patient outcomes, and value for money. But the policy has spawned a variety of schemes that target local people in ways that were beyond the reach of primary care trusts and family practitioner committees before them.

This selection of early success stories includes a support service for troubled families in Leicester, financing a warmer homes initiative to improve health outcomes in Greater Manchester, and an integrated alcohol strategy in Yorkshire.

Troubled families in Leicestershire

In Leicester two clinical commissioning groups (CCGs) are putting £1.5m (€1.8m; £$2.5m) over three years towards a family support service called Leicestershire Together. Louise Casey, who leads the government’s troubled families programme, has applauded the groups’ efforts.

She said that troubled families nearly always have a history of physical violence and sexual abuse that leads, among other things, to antisocial behaviour, crime, truancy, and chronic health conditions. “GPs will know these families, often for more than a generation,” said Casey.

Casey acknowledged that tackling the problems of troubled families was “tricky territory” but that no one was doing enough. “You can get a cast for a broken arm, but if that broken arm is from a violent partner is that enough?” she asked.

The government estimates that £9bn is spent on troubled families every year—an average of £75  000 per family. Of this, £8bn is spent reacting to the consequences of the families’ problems, with just £1bn going towards helping …

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