Table 1.

Healthcare network implications of primary care-led commissioning organisations

	Coordinating mechanism	Key features	Governance and autonomy
	(Ham, Smith and Eastmure 2011; Ham 2008)	(Mannion 2011; Checkland, Coleman, Harrison et al 2009)	(Curry, Goodwin, Naylor, et al 2008; Smith and Goodwin 2002)
General practitioner fundholding scheme (GPFH)	Market driven/emphasis on competition, strong procurement focus	Good for local commissioning and healthcare practice, local coherence Increased inequities	No clinical governance, control of real budget, independent body
Total purchasing pilots (TPPs)	Market driven/emphasis on competition	Better integrated purchasing and provision Higher costs and risks	No clinical governance, control of indicative budget, body within health authority
Primary care trust (PCTs)	Market driven/emphasis on competition, focus on administration of purchasing	Better control, budget allocation/management and economies of scale due to centralisation Less clinical input	Statutory organisation, governed by PCT board (includes clinical input), own budget
Practice-based commissioning (PBC)	Market driven/emphasis on competition, transactions oriented	Increased engagement of clinicians Higher management and transaction costs	Led by general practitioners (GPs), little clinical governance, indicative budget, voluntary scheme
Clinical commissioning groups (CCGs)	Network-centric, trust, collaboration driven with emphasis on good communication, some degree of accountability	Potential to encourage innovation, best practice, higher quality, integration and cost-effectiveness of commissioned services High risk of network instability	Clinical (GP) governance, real budget (2013), independent body, compulsory scheme