Table 1

Healthcare network implications of primary care-led commissioning organisations

Coordinating mechanismKey featuresGovernance and autonomy
(Ham, Smith and Eastmure 2011; Ham 2008)(Mannion 2011; Checkland, Coleman, Harrison et al 2009)(Curry, Goodwin, Naylor, et al 2008; Smith and Goodwin 2002)
General practitioner fundholding scheme (GPFH)Market driven/emphasis on competition, strong procurement focusGood for local commissioning and healthcare practice, local coherence
Increased inequities
No clinical governance, control of real budget, independent body
Total purchasing pilots (TPPs)Market driven/emphasis on competitionBetter integrated purchasing and provision
Higher costs and risks
No clinical governance, control of indicative budget, body within health authority
Primary care trust (PCTs)Market driven/emphasis on competition, focus on administration of purchasingBetter control, budget allocation/management and economies of scale due to centralisation
Less clinical input
Statutory organisation, governed by PCT board (includes clinical input), own budget
Practice-based commissioning (PBC)Market driven/emphasis on competition, transactions orientedIncreased engagement of clinicians
Higher management and transaction costs
Led by general practitioners (GPs), little clinical governance, indicative budget, voluntary scheme
Clinical commissioning groups (CCGs)Network-centric, trust, collaboration driven with emphasis on good communication, some degree of accountabilityPotential to encourage innovation, best practice, higher quality, integration and cost-effectiveness of commissioned services
High risk of network instability
Clinical (GP) governance, real budget (2013), independent body, compulsory scheme