Can general practitioner commissioning deliver equity and excellence? Evidence from two studies of service improvement in the English NHS.
OBJECTIVE
To explore some of the key assumptions underpinning the continued development of general practitioner-led commissioning in health services.


METHODS
Qualitative data from two studies of service improvement in the English NHS were considered against England's plans for GP-led commissioning. These data were collected through in-depth interviews with a total of 187 professionals and 99 people affected by services in 10 different primary care trust areas across England between 2008 and 2009.


RESULTS
Internationally, GPs are seen to have a central position in health systems. In keeping with this, the English policy places emphasis on the 'pivotal role' of general practitioners, considered to be ideally placed to commission in the best interests of their patients. However, our evidence suggests that general practitioners do not always have a pivotal role for all patients. Moreover, it is planned that the new commissioning groups in England will not be subject to top-down performance management and this raises the question of how agreed quality standards will be met under the proposed new system.


CONCLUSIONS
This paper questions the assumption that GPs are best placed to commission health services in a way that meets quality standards and leads to equitable outcomes. There is little evidence to suggest that GPs will succeed where others have failed and a risk that, without top-down performance management, service improvement will be patchy, leading to greater, not reduced, inequity.
Social Policy Research Unit, University of York, Heslington, York, UK. kate.gridley@york.ac.uk
Kate
K
Gridley
Gemma
G
Spiers
Fiona
F
Aspinal
Sylvia
S
Bernard
Karl
K
Atkin
Gillian
G
Parker
D003284:Contract Services / Q000458:organization & administration; D004739:England; D055317:Evidence-Based Practice; D058005:General Practitioners; D006302:Health Services Research; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D036301:Qualitative Research; D058996:Quality Improvement; D011787:Quality of Health Care; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards