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Objectives: To explore some of the key assumptions underpinning the continued development of general practitioner-led commissioning in health services., Methods: Qualitative data from two studies of service improvement in the English NHS were considered against England's plans for GP-led commissioning. These data were collected through in-depth interviews with a total of 187 professionals and 99 people affected by services in 10 different primary care trust areas across England between 2008 and 2009., Results: Internationally, GPs are seen to have a central position in health systems. In keeping with this, the English policy places emphasis on the 'pivotal role' of general practitioners, considered to be ideally placed to commission in the best interests of their patients. However, our evidence suggests that general practitioners do not always have a pivotal role for all patients. Moreover, it is planned that the new commissioning groups in England will not be subject to top-down performance management and this raises the question of how agreed quality standards will be met under the proposed new system., Conclusions: This paper questions the assumption that GPs are best placed to commission health services in a way that meets quality standards and leads to equitable outcomes. There is little evidence to suggest that GPs will succeed where others have failed and a risk that, without top-down performance management, service improvement will be patchy, leading to greater, not reduced, inequity.

Aspinal F., Gridley K., Bernard S. & Parker G. (2012) Promoting continuity of care for people with long-term neurological conditions: the role of the neurology nurse specialist. Journal of Advanced Nursing 68(10), 2309-2319. Abstract Aims. To identify service models that provided care co-ordination for people with long-term neurological conditions in the UK. Background. The successful management of long-term neurological conditions needs sophisticated management across several health, social care and other service boundaries, as well as involvement of people with long-term neurological conditions and their support network. Yet, fragmentation of, and limited access to, support has been evident for over 20 years. Design. This study employed a mixed-method approach, including a systematic review, qualitative case studies and a quantitative national survey. This paper reports findings from the qualitative case study element of the research. Methods. In-depth (qualitative) case studies were conducted in six neurology 'service systems' in the UK representing geographic and demographic diversity. The research took place between November 2007-May 2008. The concept of 'continuity of care' was used as a framework for our case studies. Qualitative methods, including telephone and face-to-face interviews, were used to explore people's experience of continuity of care. Data were managed and analyzed using the Framework technique. Findings. Neurology nurse specialists were able to contribute to all elements of continuity of care for people with long-term neurological conditions. Conclusion. Their specialist knowledge about the condition and local services, flexibility, co-ordinating role, and their holistic and collaborative approach to practice, are key factors in nurse specialists promoting continuity of care. Nurse specialists exist in many different clinical areas and in many countries. Findings about the importance of their role in promoting continuity of care have important implications for UK and international policy and practice. [ABSTRACT FROM AUTHOR]