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Comprehensive health services cannot be planned on the basis of 7.000 people - the average list size of a fundholding practice. Services such as casualty and kidney transplantation must be planned on populations of hundreds of thousands. GP commissioning has developed from the spontaneous reaction against fundholding by some GPs ( both fundholding and non-fundholding) into a comprehensive, systematic approach towards the planning and monitoring of health services. This book is the first to explain GP commissioning in its own right. It documents the history, theory and practice of GP commissioning and places it within the current political situation faced by the NHS. It shows how commissioning goes beyond fundholding. Commissioning is a more cost-efficient alternative, is clinically effective and its spontaneous development implies it is more in keeping with the basic tenets of the National Health Service. The difficult areas of financing, commercialization and rationing of health care are all covered. The book also explores the relationship between GP commissioning and evidence-based medicine, both of which can contribute to a systematic approach towards the planning and provision of health care into the next century. With contributions from GP commissioners, health services managers, leading academics, the Secretary of State, and the former Shadow Secretary of State for Health, this book will inform the important debate on the structure of primary care. It is vital reading for all those with an interest in the future of the health service.