The health and social care reforms in England are an opportunity to develop an innovative programme that marries values and evidence and that is at once person-centred and clinically sound. Values-based practice is not dependent on the reforms: if the reforms did not occur, this would still be the right time to establish more effective processes of clinical commissioning; but conversely given that the reforms may occur, then the opportunity should be taken to improve the values basis of decision-making. Many burgeoning strands of action demonstrate this: the QIPP ‘Right Care’ programme (2011), an emphasis on shared decision-making, attempts to achieve integration, and a focus on GP-led clinical commissioning, all point to a gathering of opinion that will become an unstoppable force for change. Engaging GPs and other clinicians in an integrative process that encourages values-based and evidence-based practice as a shared approach to improving the doctor–patient and professional–service user relationships in the context of a population perspective.

Primary care commissioning:

Previous attempts at ensuring that evidence and local values were in harmony have had a mixed press. Since the advent of the internal market in 1991, a number of initiatives have been tried to get primary care physicians more engaged in commissioning. From fund-holding during the early 90s to practice-based commissioning, there has been a succession of mechanisms proposed, each of which has been found wanting by one section of society or another.