Can primary care be both patient‐centred and community‐led?

Examines the relationships between the macro‐, meso‐, and micro‐levels in the NHS at the end of the fundholding period and considers their contemporary implications for primary care groups (PCGs) and local health care co‐operatives (LHCCs). Fundholding achieved some success in challenging the way in which services were provided at the micro‐level (the practice), but had a less marked effect in terms of changing service provision at the health authority (meso‐) level or in developing collaborative working with trusts and health authorities in strategic decision making. The health authorities prioritized alternative models of devolved commissioning. Trusts regarded fundholders as a distraction who exerted influence and commanded trust management time disproportionate to their “market share”. PCGs and LHCCs represent a shift back to the meso‐level in service planning and purchasing. As such there is a risk that the micro‐level benefits of fundholding and other forms of devolved commissioning will be lost, while uncertainties remain regarding the capacity of PCGs and LHCCs to incorporate GPs into a collaborative approach to strategic decision making.