In March, BMJ published a paper under the section heading of ‘Head to Head’ debate; the subject was that of imposing fines on general practitioners (GPs) in the NHS if the numbers of avoidable emergency admissions to hospitals increase.1 Now that service commissioning is operational, even if it is in its early days, such financial levers are not a theoretical concept.

In the yes camp, the argument is:

• Professional and organisational thinking can be siloed.

• Emergency admissions account for a relatively small proportion of activity in specialist care but a large proportion of cost.

• Hospital doctors do not think there is any consistency outside of hospital care.

• Many emergency admissions are due to exacerbations of long-term conditions, failed coordination of care and failed proactive community and primary care management.

• Clinical commissioning offers the chance to tackle the complex issues relevant to emergency …