ABSTRACT
The development of general practitioner (GP) commissioning is a remarkable story of success. It is an approach to the 1990 changes in the National Health Service (NHS) that has been developed largely by GPs themselves. If GPs are to work in partnership with the DHA then resources must be made available to establish, support and sustain that relationship. Commissioning is largely a strategic exercise. A health authority needs to be enthusiastic about developing commissioning, at liberty to do so, and with resources available to support the exercise. Few health authorities yet understand what is required of them to make GP commissioning effective. Locality co-ordinating groups are important bodies, offering cohesive planning at the same time as sensitivity to the needs of local communities. Equity of access according to clinical need is a fundamental, inviolate principle of the NHS. The considerable advantages of commissioning come to nothing if the participating GPs fail to work within agreed boundaries.
