Intended for healthcare professionals

Observations The Best Policy

Commissioning’s identity crisis

BMJ 2015; 351 doi: (Published 18 November 2015) Cite this as: BMJ 2015;351:h6008
  1. Nigel Edwards, chief executive
  1. 1Nuffield Trust, London, UK
  1. nigel.edwards{at}

If current trends continue, holding on to the N in NHS may become much more difficult

Almost since its inception, in the early 1990s, NHS commissioning—the process of buying and planning healthcare for local areas—has suffered from a crisis of identity and confidence. Critics have denounced it as unnecessary bureaucracy; even those involved have questioned its purpose or effectiveness; and frequent mergers and wholesale reorganisations of the bodies involved in commissioning have destroyed organisational memory, removed talented staff, and disillusioned many of the few clinicians who could be persuaded to become involved.

Almost 25 years after the “purchaser-provider split” in England, questions are yet again being asked about the purpose of commissioning as attempts are made to sort out the muddle left by former health secretary Andrew Lansley’s reorganisation, which in 2013 abolished primary care trusts and handed commissioning to GP led groups. Politicians and officials are clear that they want to revisit commissioning policy without the pain and embarrassment of having to legislate again or undertake any visible reorganisation.

You might think that the NHS would be better served if it spent less time on such recondite and self referential stuff. But the absence of a strategic body able to pull together local organisations is proving …

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