TY - JOUR T1 - Practice-based commissioning: are there lessons from fundholding? JF - British Journal of General Practice JO - Br J Gen Pract SP - 328 LP - 329 VL - 57 IS - 537 AU - Russell Wynn Jones AU - Edin Lakasing Y1 - 2007/04/01 UR - http://bjgp.org/content/57/537/328.abstract N2 - Responding to practice-based commissioning (PBC), enhanced service bids, and alternative provider medical services (APMS) is proving difficult. This should be no surprise — their design and implementation is ad hoc as they undergo frequent revisions and reinterpretation. In this article, we use our practice's experience to highlight difficulties and propose change.PBC is a misnomer — it is not practice based but locality based, and is of the same size or larger than the recently deceased primary care trusts (PCTs). It, therefore, runs the risks of inheriting all the PCT foibles and weaknesses that contributed to their demise; principally limited clinical involvement, weak leadership and decision making and poor financial management relative to usual commercial practice.1 Not a promising starting point for improving clinical care and achieving financial stability.Our practice is approved as an investigator-led research centre by the RCGP. We, like others, hoped that enhanced services would bring new levels of clinical competence to primary care, improving the experience of illness via smoother patient pathways and financial stability. Unhappily this is proving illusory. The practice had prepared, and won, an enhanced service bid to deliver heart failure diagnostics and non-obstetric ultrasound, intended to run simultaneously as a service to patients across the whole PCT area, as well as a research project evaluating patient pathways and clinical outcomes. The success was short-lived: it was withdrawn after the … ER -