Published: 21/10/2004, Volume II4, No. 5928 Page 5

Primary care trusts might react to the new practice-led commissioning policy as 'a threat to their existence' and some practices could 'be tempted into adversarial relationships with PCTs', national director for primary care David Colin-Thomé has admitted.

However, Dr Colin-Thomé, speaking to HSJ about the impact of new guidance on primary careled commissioning, said that PCTs should use the policy to improve clinical engagement.

'We are not getting rid of PCTs; we need them very strongly, but we are asking them to commission in much more radical ways than we previously have, ' he said.

'They will only be able to do that through clinical engagement. It may add a bit of tension - some PCTs may see it as a threat to their existence, and some practices may be tempted into adversarial relationships with PCTs. I do not deny that, but we at the DoH are keen for this to be a way of building effective relationships, ' he adds.

And a report by the Health Foundation, launched today, concludes that none of the methods of primary care-led commissioning tried so far have had a significant influence on secondary care, apart from reducing some waiting lists.

But it has had positive effects on primary and intermediate care in areas such as developing a wide range of practice-based services, according to the report.

These services have encouraged new forms of peer review and quality assessment across practices, which in turn has led to new forms of specialist primary care.

The foundation looked at all primary care-led commissioning types employed across the UK over the last 20 years as a basis for its proposals for a new multi-level, locally determined commissioning structure for the NHS.

Examining patient choice, single practice, multi practice, primary care organisation/PCT, lead PCT and national commissioning approaches, the report concludes that there 'is no ideal size for a commissioning organisation', as different services require commissioning at different population levels.