Traditionally, GPs have always directed the fl ow of resources through a referral and prescribing activity. They are both providers (through their contract with primary care trust) and commissioners (through the referral of registered patients to secondary care or other providers). Practice based commissioning encourages GPs to make necessary referrals by adhering to ‘care pathway protocols’, to prescribe cost-effectively and to avoid unnecessary hospital follow-ups. Under practice-based commissioning, a primary care team can provide diagnostic services and preventive care thus reducing hospital admission. The boundary between the primary and secondary care interface is gradually being eroded as the care provided previously by the secondary care specialist is now provided by the primary care specialist in a primary care setting.