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Introduction

1. There is nothing new in the concept of Practice Based Commissioning. The 1998 white paper, The New NHS, stated that, 'over time, the Government expects that ... PCTs will extend indicative budgets to individual practices for the full range of services'. In June of this year, The NHS Improvement Plan indicated, 'from April 2005, GP practices that wish to do so will be given indicative commissioning budgets'. This paper represents our latest thinking on a concept that has developed over several years.

2. The right to hold a budget and our willingness to see it as a first step towards the development of a sophisticated range of ways in which practices are involved in commissioning, are entirely consistent with the principle of greater devolution. The Department recognises the important role that GP practices play in commissioning services for their patients and local populations. Further, there are changes in the NHS that means that Practice Based Commissioning will assume greater importance in the system overall. These include:

3. By promoting practice level budgets for commissioning the Department envisages a number of ways in which patients will benefit:

Further, there are ways that the NHS as a whole, and hence, the public will benefit from:

4. There is good reason to be confident in these expectations because of the evidence supporting Practice Based Commissioning. This was recently summarised in the report on Practice Based Commissioning published by the Kings Fund and endorsed by the NHS Alliance and National Association for Primary Care. Further, professional bodies have also indicated the need to engage clinicians in the commissioning process.

5. GP practices are one of the main determinants of health care utilisation.  Furthermore, with their central co-ordinating function, often they have a major influence on what care a patient receives and how a patient exercises choice. At present, with the possible exception of prescribing, all this comes without any need for practices to consider how they are using health service resources and often without the financial ability to secure better and more innovative services for their patients.

6. The same is true, albeit to a lesser extent, of other clinicians working in primary care. Community nurses for example, could hold an indicative budget for the benefit of their patients. This is discussed in the section on 'How do we anticipate Practice Based Commissioning will develop over time?'

7. In summary, Practice Based Commissioning is a key part of improving the NHS. PCTs should encourage their practices to take on budgets for commissioning, indeed many are already doing so; the expectation is that every PCT will do so, maximising the potential of this policy as far as possible.

• Download Practice based commissioning: Engaging practices in commissioning (PDF, 218K)
• Updated version of practice based commissioning guidance