Commenting on today's report from the Audit Commission into practice-based commissioning (PbC), King's Fund chief executive Niall Dickson said: 'The Audit Commission is right that moves to devolve greater power and financial control to GPs over the services they commission for patients has had limited impact. Most GPs are still not engaged effectively in practice-based commissioning (PbC).

'However, PbC has the potential to deliver better care to patients and more cost-effective services. This central reform is still relatively new and is managed by PCTs - most of which have only just emerged from extensive reorganisation. It remains one of the few levers to help meet the government's objective of delivering more care closer to people's homes.

'But what is equally clear is that we are still facing some of the same questions we faced in the 1990s during previous attempts at engaging GPs with commissioning in the days of GP fundholding, especially in terms of how best to engage the majority of GPs in the reform. It is unclear whether we have the right incentives in place to ensure GPs will engage effectively. Too often GPs are focusing on providing new services themselves in a piecemeal way rather than commissioning new initiatives and services to meet the wider health needs of their local communities.

'It's clear that several barriers must be overcome to make this a success. We know that GPs and others in primary care suffer from a lack of support from their PCT, financial constraints and excessive bureaucracy. PCTs themselves have only just recovered from significant reorganisation but there may be more opportunities now for PCTs to be creative in giving practice-based commissioners the right support. If this reform is to succeed, practice-based commissioners need prompt financial information and sound business planning to design the right services to meet local health needs.'

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 funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.

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