ABSTRACT
General practitioners (GP) have a major influence on what care a patient receives and how that patient can exercise choice. Traditionally, GPs have always directed the flow of resources through a referral and prescribing activity. Before practice-based commissioning (PBC) there were no financial incentives to secure better, innovative and cost-effective services for their patients. PBC encourages GPs to make necessary referrals by adhering to 'care pathway protocols', to prescribe cost-effectively and to avoid unnecessary follow-up. The Audit Commission's recent report described commissioning as a way of managing financial risks as well as a means of improving services and use of resources. The PBC budget should be based on the last available 12 months of activity at 2008–09 prices. Consider taking on patients from neighbouring practices that do not offer a chronic obstructive pulmonary disease service, or that provide a poor-quality service, making it clear that a planned service will be provided for their patients free of charge.
