Yesterday I posed the suggestion that one of the main problems for NHS commissioning was the split between the practicality of doing the commissioning and the strategic level of planning. The standards of plans varied between ‘OK’ and ‘very good’ but for some PCTs the use of their powers and capacity of their commissioning to put those plans into effect was very minimal. Commissioning, in a number of places, simply meant handing out the money to the same providers as last year plus or minus a few percentage points. This continuation of past commissioning activity took place even where there was recognition – in the plans – that radical changes to health care were needed in the locality.

The best PCTs had actively brought their GPs into the commissioning process because they recognised that they were involved in the day to day business of referring patients. As a consequence they realised that in order to meet their patient’s needs, health care needed to change. Commissioning would provide GPs with a new engine to bring about those changes.