Primary care groups (PCGs) and primary care trusts (PCTs) are the way forward for primary care in the UK. These groups of general practitioners (GPs) and community nurses, organized along geographical lines, will need to forge relationships with other organizations and key players to a much greater extent than has been necessary hitherto. Currently PCGs most closely resemble the total purchasing pilots (TPPs), which have been the subject of a national evaluation. This paper reports on the evidence collected by interviewing key stakeholders – lead GPs, health authority (HA) leads, project managers and social services representatives – about how relationships developed in TPPs and how this might be relevant to PCGs and PCTs. The importance of good relationships with HAs was recognized by the TPPs, and the HAs were seen as having an important strategic role. Relationships with social services were slow to start for historical reasons, and had not progressed particularly far by the end of the study. Similarly, involving patients and the wider public in TPPs was problematic, and there was a lack of guidance about the most appropriate ways of proceeding. The evidence suggests that progress will be slow and the problems encountered by TPPs are likely to become apparent as PCGs develop, and with the transition to trust status. There is much for the primary care groups and trusts to learn from the TPPs.

Aim: To describe a general practice commissioning project including 19 nonfundholding practices in Buckinghamshire: its structure, aims, representativeness, outcomes, costs and sustainability, and lessons learned from the process over the first 18 months.

Method: Examination of project documentation; postal questionnaire to all 73 participating GPs and to eight key players in the Health Authority (response rate 72%); and in-depth interviews with six Health Authority staff and 15 general practitioners (GPs).

Results: A representative structure and process were established for GP involvement in commissioning. 75% of GPs were involved. Mutual understanding improved between the GPs and the Health Authority. Service improvements identified included developments in orthopaedics, community psychiatric nursing, physiotherapy and ophthalmology. Lessons were learned about the importance of open and continued communication; clarity about expectations, accountability, power and responsibility; development of relationships and understanding in joint working; the time required to achieve tangible results; and the need to develop GPs' commissioning skills.

The project cost about £10000 in cash and £32500 in staff time in the first year. Participants perceived their input as sustainable.

Conclusion: The results of the study suggest that the success of Primary Care Groups will depend on ensuring engagement of all parties in the process, clarifying roles, responsibilities and expectations, identifying shared agendas, developing explicit and achievable goals, and a commitment among all parties to implement recommendations. The work and time involved in developing mutual respect and shared understanding, and in developing commissioning skills need to be acknowledged.

The objectives of this study were to identify the variation in primary care provision in primary care groups (PCGs), to describe the developmental challenges that they face, and to show where investment in primary care should be targeted. Face-to-face semi-structured interviews and postal questionnaires were used. The setting was a 15% (n = 72) random sample of PCGs in England, stratified by NHS region, and the study subjects were PCG Chief Officers, Chairs and health authority PCG leads, as well as PCG board members. In total, 21 PCGs (31%) reported no GP recruitment and retention problems and anticipated none in the next 5 years, but 13 PCGs (19%) had major problems. A total of 13 PCGs (19%) had no problems with staff shortages in general. Problems with access were often confined to particular areas or practices. Fundholding services that were either discontinued or under threat included counselling, physiotherapy, complementary medicine and outreach clinics. A total of 22 PCGs (24%) planned to redistribute GMS cash-limited budgets to practices, but 44 PCGs (49%) had no such plans. In addressing poorly performing practices, the emphasis was against taking punitive action. It is concluded that PCGs have inherited diverse practice groupings which have not previously been united in a single organization. Most of them face staffing problems, but few have developed detailed workforce plans. The main priorities for investment are prescribing support, information, nursing staff and clinical governance. Many PCGs had discontinued fundholding services in the interests of equity. Without a committed workforce, and an infrastructure to support improved services, the goal of improved services for all will be difficult to achieve.