Abstract

Practice-based commissioning (PBC) is no longer
the new kid on the block of NHS reform. A direct
descendant of the purchaser–provider split conceived
by Margaret Thatcher and Alan Enthoven as part of
the market reforms of the 1990s, referred to in earlier
policy documents and developed in the White Paper on community care, Our health, our Care, our Say it is nevertheless a move towards greater partnership and
patient centredness in health care. Whereas general
practice (GP) fundholding encouraged individual entrepreneurialism which subsequent primary care groups
and trusts were never able to match, PBC, by working
directly at the coalface of primary care, does have the
potential to lead to rapid transformation more widely.