Practice-based commissioning should be changed to let mixed teams of hospital specialists and GPs decide how budgets are spent, according to a report by a leading health policy analyst.
Chris Ham, professor of health policy and management at Birmingham University, claims health policy is lagging behind stated NHS priorities.
In a report for the Nuffield Trust, he says clinicians from primary and secondary care should work together to prevent and treat chronic diseases.
'Practice-based commissioning is not effective because it doesn't bring primary care teams - nurses as well as doctors - together with the specialist teams based in hospitals,' he said. He called for wider use of flexible primary care contracts to encourage joint working.
Professor Ham said Lord Darzi's review of the NHS must provide 'a coherent and credible account' of how clinical integration would work. But he admitted some GPs would be reluctant to relinquish control over budgets.
Dr Kailash Chand of the British Medical Association's GPs committee said he was not opposed to joint commissioning, but he added: 'Practice-based commissioning has got to find its feet first.'