title: The 'added value' GPs bring to commissioning: a qualitative study in primary care.
abstract: BACKGROUND
  The 2012 Health and Social Care Act in England replaced primary care trusts with clinical commissioning groups (CCGs) as the main purchasing organisations. These new organisations are GP-led, and it was claimed that this increased clinical input would significantly improve commissioning practice.
  
  
  OBJECTIVE
  To explore some of the key assumptions underpinning CCGs, and to examine the claim that GPs bring 'added value' to commissioning.
  
  
  METHODS
  In-depth interviews with clinicians and managers across seven CCGs in England between April and September 2013.
  
  
  METHODS
  A total of 40 clinicians and managers were interviewed. Interviews focused on the perceived 'added value' that GPs bring to commissioning.
  
  
  RESULTS
  Claims to GP 'added value' centred on their intimate knowledge of their patients. It was argued that this detailed and concrete knowledge improves service design and that a close working relationship between GPs and managers strengthens the ability of managers to negotiate. However, responders also expressed concerns about the large workload that they face and about the difficulty in engaging with the wider body of GPs.
  
  
  CONCLUSIONS
  GPs have been involved in commissioning in many ways since fundholding in the 1990s, and claims such as these are not new. The key question is whether these new organisations better support and enable the effective use of this knowledge. Furthermore, emphasis on experiential knowledge brings with it concerns about representativeness and the extent to which other voices are heard. Finally, the implicit privileging of GPs' personal knowledge ahead of systematic public health intelligence also requires exploration.
authors.affiliation: Centre for Primary Care, University of Manchester, Manchester, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Perkins
authors.affiliation: Centre for Primary Care, University of Manchester, Manchester, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Coleman
authors.affiliation: Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Wright
authors.affiliation: Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK.
authors.forename: Erica
authors.initials: E
authors.lastname: Gadsby
authors.affiliation: Centre for Primary Care, University of Manchester, Manchester, UK.
authors.forename: Imelda
authors.initials: I
authors.lastname: McDermott
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Petsoulas
authors.affiliation: Centre for Primary Care, University of Manchester, Manchester, UK.
authors.forename: Kath
authors.initials: K
authors.lastname: Checkland
mesh_terms: D026683:Advisory Committees; D058005:General Practitioners; D018166:Health Care Reform / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D011320:Primary Health Care / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom
keywords: NHS; clinical commissioning groups; commissioning; general practitioners; service development