Medical experts have expressed concern over "persistent weaknesses" in how English GPs choose which health services to buy for local people.
Writing in the British Medical Journal (BMJ), GP Stephen Gillam and Richard Lewis, director at Ernst and Young, said there was little evidence that 20 years of forms of practice-based commissioning (PBC) had greatly affected hospital services.
The system, where doctors have some control over their budget and decide which health services to sign up for to serve their community – has been central to policy since 2005.
The pair believe plans to "reinvigorate" PBC must not only include extra funding, but also tackle endemic problems, including a lack of clinical engagement, organisational immaturity, insufficient support from management, limited public involvement or accountability, and lack of information on which to base commissioning decisions.
They say the government should look towards a "matrix" model that places different responsibilities at different levels, along with proposals by the Royal College of General Practitioners' to create practice federations in order to develop expertise.
And new "integrated care organisations" would offer real budgets to practices in return for the responsibility to manage health and population care.