When it was first proposed that PHBs be piloted within the NHS, primary care trusts (PCTs) were responsible for commissioning services. Over the three years of the pilot, PCTs built up valuable knowledge and expertise about the best way to implement PHBs locally. However, when the Coalition government came into power in 2010, it proposed a sweeping round of structural reforms to the NHS that replaced PCTs with CCGs, alongside other far-reaching changes. As a result of these reforms, PHBs will be rolled out in a different commissioning environment from the one in which they were piloted. This may have its advantages: GPs spend the majority of their clinical practice seeing people with long-term conditions at all levels of complexity, and as lead commissioners within CCGs they may, therefore, be quicker to appreciate the benefits of a personalised approach. However, with CCGs only fully taking over commissioning responsibilities from PCTs in 2013, the challenge they face is to be ready for the roll-out of PHBs by April 2014.

Given the lack of stability in the wider NHS landscape, there is a risk that the momentum behind PHBs will wane as the deadline for roll-out approaches. Innovation that challenges established practice, as personalisation does, can be difficult to sustain in an uncertain, changing environment. Staff are distracted by job losses and new roles rather than focusing on improving the way in which they work with individuals who use services. A further distraction is the ongoing efficiency drive in the NHS. Latest estimates suggest that the NHS in England faces a funding gap of £14 billion between 2014/15 and 2021/22, even if funding for the NHS rises in line with GDP growth (Roberts et al, 2012). Bridging this gap will require a laser focus on efficiency savings, shifting attention away from PHBs. At the same time, the 2012 Health and Social Care Act that cemented the government's structural reforms in legislation undeniably presents opportunities for PHBs. Its guiding principle of ‘nothing about me, without me’ fits closely with the individual choice and control offered by PHBs (DH, 2012g). This chapter looks at the new landscape of the NHS and how this affects PHBs. The second half of the chapter focuses in detail on commissioning and the advantages and challenges that PHBs present for CCGs.