- This report summarises the main results of a survey of approaches to commissioning. All health authorities were surveyed and a 100 per cent response was achieved. The survey sought to map different approaches to commissioning and to assess the impact of these approaches from the perspective of health authorities. The survey showed that a wide variety of approaches to GP commissioning was in existence in the NHS in 1997. These included not only the five principal categories used at the outset of the survey (multifunds, fundholding consortia, locality commissioning, commissioning by groups of practices and health authority wide groups), but also joint commissioning, commissioning focused on particular client groups or specialties, and a range of area based approaches. The pattern that emerged suggested that different approaches had different strengths. The survey suggested that multifunds and fundholding consortia had had a greater impact than other approaches on prescribing, the provision of extended primary care services, referrals and inpatient waiting times. By contrast, locality commissioning, commissioning by groups of practices and health authority wide groups had had a greater impact than multifunds and fundholding consortia on services for chronically mentally ill people and continuing care policy and arrangements. All approaches had made a beneficial impact on service quality, and equally all had had a limited impact on emergency admissions. The report considers the future of commissioning and the implications of government policy.