The King's Fund welcomes return of power to the practice

The government should do more to encourage family doctors to take responsibility for commissioning hospital services on behalf of their patients, according to The King's Fund.

In a report published today, The King's Fund sets out the benefits of sharing commissioning power with family doctors and other primary care staff - a policy known as practice-led commissioning. Ministers have sanctioned this approach as part of a wider strategy to increase the influence of front-line clinical staff and to make the NHS more responsive to patient needs.

The report Practice-led Commissioning: Harnessing the power of the primary-care frontline points out that the lack of detailed guidance from the Department of Health may lead to different forms of practice-led commissioning. But it argues that this diversity may well prove beneficial so long as primary care trusts and GP practices act quickly to agree how this should be enacted locally.

The King's Fund chief executive Niall Dickson said:

'This is an exciting development not least because two of the key organisations representing primary care are broadly agreed on the way forward - both the National Association of Primary Care and the NHS Alliance have helped us develop this report and endorsed this approach. This is a topic that has been controversial in the past but our report shows there could be real benefits from giving local practices more scope to shape services and with fewer drawbacks than the experiments in the 1990s.'

The report's author Richard Lewis said:

'Practice-led commissioning will mean big changes to the way the NHS organises itself and could help primary care trusts finally get to grips with one of their toughest challenges – how to engage family doctors and other staff in the community. Primary care trusts, with small groups of doctors and nurses on official boards, have not yet made much impact on wider NHS decision making, as was originally hoped. Nor have primary care trusts yet proved adept at this crucial commissioning role. However, this could all change as practice-led commissioning will devolve power to the front line and should place professionals firmly in the driving seat.

'This could also help reduce the burden on already over-stretched hospitals. It should help reorganise health care delivery around local services and act as a powerful incentive to pull patients back into the community. It's a great idea, the problem is so far it has failed to receive the attention of other government health reforms.'

The report highlights the similarities and differences between practice-led commissioning and GP Fundholding, a prominent feature of the Conservative government's internal market in the NHS in the 1990s – under that scheme practices were allocated a cash-limited budget to purchase services directly from health care providers on behalf of their local communities.

The King's Fund chief executive Niall Dickson said:

'There are similarities to earlier health service reforms, but the context is different. Patients in all practices should increasingly be offered choices about where they are treated which should avoid the earlier concerns about creating a two tier system. And the new market will operate in a different way with fixed prices for all operations which should remove the potential for individual practices to lever favourable prices from hospitals desperate for extra income. All that should go some way to reducing anxiety over potential inequities that in theory could re-emerge if some GP practices are given greater freedoms to commission over others.'

Read the report: Practice-led Commissioning: Harnessing the power of the primary-care frontline

Notes to editors: 

1. For further information or interviews with The King's Fund staff, please contact Daniel Reynolds in the media and public relations office on 020 7307 2581 or 07831 554927, or Michael Moruzzi on 020 7307 2585.

2. Richard Lewis is Visiting Fellow in Health Policy at The King's Fund. He carries out policy analysis and research, with a special interest in decentralisation in health care, managed care in the United States, and primary care. He has a background in health service management and spent several years as executive director of a large health authority in south-west London.

3. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.