The challenge of commissioning for populations.

The health reforms in England have elicited considerable public and professional angst and concern. There has also been a flurry of activity among GP commissioners and health managers trying to set up the clinical commissioning groups as well as simultaneously figure out how to carry out the task of commissioning. In the process, several key issues have surfaced that need to be addressed. First, what is the vision of commissioners and for whom do we commission; do we act primarily in the interests of our patients, our communities, our practices, our local health services, or for ourselves? Secondly, how do we reconcile competing and differing voices in the commissioning forum; what are the values and considerations that underpin our decision-making? The need to articulate this is crucial as it informs the strategic direction of commissioning activities.