Exploring the role of localities in health commissioning: A review of the literature

The emerging pattern of NHS purchasing has prompted many health authorities in Britain to experiment with a variety of different approaches to locality-based commissioning. But published accounts of these experiments are few and little attempt has been made to analyse the resulting experiences in policy terms. This paper reviews the specific literature on locality commissioning in health services and some of the reasons for its emergence. It is also argued that since initiatives of this kind typically seek to address a wide agenda, involving a wide range of stakeholders, there is also a case for examining the wider policy background, including the literature on community development, decentralization and joint collaboration. An account is thus presented of the policy context within which locality commissioning experiments are taking place, and hence the principal issues which are likely to prove contentious or otherwise problematic.