Are the Health of the Nation's targets attainable? Postal survey of general practitioner's views.

Objective: To describe the impact, direct costs of, and participants’ attitudes to the first two years and eight months of locality commissioning in Avon. Design: Retrospective description of programme. Setting: Thirteen localities in Avon Health Authority area, covering 982 000 population and 147 general practices. Methods: Postal questionnaire survey of 147 general practitioners (one per practice); interviews with and questionnaire survey of 13 lead general practitioners and 13 so called link staff from the health authority. Main outcome measures: Locality initiatives, perceived influence, general practitioners’ attitudes, management costs. Results: Twenty initiatives were identified that had changed services to patients, and another nine were planned. The commonest initiatives concerned primary mental health care (seven), nurse specialists for primary care of chronic diseases (three), referral and clinical practice guidelines (seven), and access to hospital outpatient departments (one, with two others planned). Localities were more likely to have influenced the authority, trust managers, and consultants than social services, community health councils, and voluntary organisations. Activity varied between localities, lead general practitioners estimating that 120/147 (82%) of practices had been involved in locality meetings (range 44-100% in different localities). The authority had spent 6 p per capita on running the scheme, and the total time used by general practitioners for locality commissioning was estimated at 1.5 whole time equivalents. Conclusion: Locality commissioning has selectively changed services with limited extra funding and without delegation of hospital and community health service budgets. General practitioners wanted more policy and financial support. Further development should be based on evidence of costs, benefits, and limitations of locality commissioning schemes.