We worked with the commissioners of primary care (NHS England) as well as the local medical committee (LMC) and our neighbouring practices to try to find a solution.
24 This study offers evidence to clinicians, managers, and commissioners of primary care services in the NHS as to the acceptability, effectiveness, safety, and costs of PAs when substituting for doctors for part of the primary care workload.
The outputs could be useful for commissioners and managers of primary and secondary care child health services in carrying out local needs assessments.
They included the following: a health commissioner, four directors of primary health-care of the LGAs selected for the study, one permanent secretary of health, a chief medical director of a specialist hospital, and a director and deputy director at the ministries of health.
The commissioners of public services - local authorities, primary care trusts, government agencies - have an obligation to market test services.
In the 12-month pilot, it was not possible to identify the impact of removing practice boundaries on, for instance, referrals, overall use of primary and secondary care, costs to commissioners, equity of access or practice patient mix.
Of primary importance is to explore managers' and commissioners' perceptions of whose responsibility it is to ensure that evidence-based guidelines are applied in practice.
From the perspective of primary care provision it is acknowledged that as commissioners of services, Primary Care Trusts (PCTs) working alongside local authorities should 'identify specific communities with particularly poor health, such as travellers, migrant workers, people with learning disabilities, those living in disadvantaged areas or demographic groups' [ 49].
To understand and consider regional variation in resources, services, needs and policy we shall purposively select providers and commissioners of health and social care in primary, secondary and tertiary settings from four areas of the UK (London, Belfast, Edinburgh and Solihull).
Twenty-two health professionals including CCNT managers and staff; paediatricians; nurses; children's ward, ED and OAU staff; commissioners of children's services; GPs and primary care staff were interviewed between June 2009 and February 2010.
The data is compiled from information exchanged between healthcare providers such as hospital trusts and primary care trusts (PCTs), and the commissioners of that care, primarily the PCTs.
