Practice-based commissioning: implications for secondary care.

General practitioner (GP) practice-based commissioning (PBC) is a much debated politically driven NHS innovation at a time of ongoing change. Unlike GP fundholding it is envisaged that PBC will involve all GP practices by 2008. A possible outcome is that some current secondary care services may be commissioned in primary care in the form of local enhanced services or intermediate clinics and run by GPs with special interests. Examples where this has occurred are diabetes and anticoagulation. Similarly, private providers may be commissioned. Inevitably there will be an impact on hospital services through a possible reduction in funding and consultants being subcontracted to provide services in primary care. Issues such as clinical governance and cost-effectiveness, however, require evaluation to determine the potential effect on the working relationships and so the interface between generalists and specialists.