Commissioning is the process by which PCTs identify the health needs of their population and make prioritized decisions to secure care to meet those needs within available resources. It includes longer term strategic planning, medium term planning (three year Local delivery Plans) and the shorter term agreement and performance management of service level agreements. The process should involve the public, engage clinicians, and be conducted on a whole system basis, informed by health equity audits, and carried through with the full participation of other stakeholders including NHS Trusts, local authority(s) and the voluntary sector (NHS Modernization Agency 2004). KEY WOrDsPractice based commissioning w Health Policy w Nurse involvement C ommissioning services is a key element within NHS reforms which is still in it's infancy, with the initial changes to Primary Care Trusts (PCT) proposed in 2005. This included merging of PCTs to create larger, more powerful commissioning PCT organizations (Department of Health (DH), 2005).Since this reorganization, PCTs have received a wealth of guidance from the Department of Health, much of it aimed at improving the commissioning of secondary care services (DH 2006a, DH 2006b, DH 2006c. However more recently, guidance has been issued for better commissioning of health improvement and wider preventative services in the local community, or in partnership with local government (DH, 2007). Practice based commissioningAs with any organizational system, the visioning and shaping of the service is fundamental to its success, and therefore it is imperative that community nurses have an appreciation of the concept of commissioning, and actively engage in the process in order to improve services for their patients.This government aim of providing services that are designed, planned and developed around the needs of patients is outlined in the white paper 'Our Health, Our care, Our Say: A New Direction for Community Services (DH, 2006). Following this, the commissioning framework for health and well-being (DH, 2007) identifies eight steps to more effective commissioning: Putting the people at the centre of commissioningThis involves giving people greater choice and control over services and treatments (including self-care), and access to good information and advice to support these choices. Mechanisms will be developed to help the public get involved in shaping these services, with advocacy to support groups who find it hard to express views. Understanding the needs of populations and individualsJoint strategic needs assessment by councils, PCTs and practice based commissioners will help them better understand the needs of individuals, by using recognized assessment and care planning processes appropriately, and mitigating risks to the health and well being of individuals. sharing and using information more effectivelyIn order to make effective decisions for individuals and groups, we need to use and share information in an effective way. This includes clarifying what information...