GP commissioning: insights from medical groups in the United States

The NHS White Paper, Equity and Excellence: Liberating the NHS, contains a radical proposal: to hand control of the NHS budget to clinical commissioning groups.

NHS policy-makers can learn much from the United States as up to 2,000 doctor-led networks and groups emerged across the country from the mid-1980s onwards to contract with insurance providers and take responsibility for fixed budgets with which to deliver their patients’ care. Only a small proportion of these groups have survived to the current day.

Our report shows that many US physician groups underestimated the importance of investing in management support

As part of our work on international comparisons, senior researchers from the Nuffield Trust visited a number of medical groups led by doctors in California. This briefing paper is based on the findings from their study visit and highlights important lessons for the NHS in England as the Government prepares to transfer control of £60 billion of the NHS budget to clinical commissioning groups.

The US experience shows that holding risk-bearing budgets can motivate doctors to deliver efficient, coordinated care that reduces avoidable and repeated admissions to hospital. However, to achieve this, the groups had to ensure that primary and specialist doctors cooperated closely and were able to invest in a range of high quality and innovative services that offer alternatives to hospital care, particularly for older patients with chronic conditions.

The US experience also shows that those groups which initially underestimated the importance of investing in management support – including data and IT systems, experienced analysts, and other management and financial expertise – struggled at first to manage their responsibilities effectively

GP commissioning: insights from medical groups in the United States will be of interest to academics and researchers in this area as well as to policy-makers and commissioners of health services.