This is not a new idea (I even had a blog in Pulse about it recently), and one that has been implemented in models such the Health Maintenance Organisation, which (like the CCGs are supposed to be) are responsible for the health of their populations, and left to choose what to do 'in house', and what to subcontract.
Such an arrangement would get rid of the 'conflict of interests' that bedevils most forms of procurement in the NHS, and would align the incentives for the CCG so that if they did move activity from the acute sector into primary care, they could be sure that the resource would move too....
As long as funding streams for hospital and community care are handled separately, the NHS can never function properly
Thanks for the comment, Joe; for what it's worth, I think that single structures tend to allow a slackness of approach to emerge, and drive to disappear. What we do need highly integrated functions (to allow the seamlessness of care to develop) with very clear accountabilities, preferably based on outputs and outcomes rather than on inputs and throughputs.
The best simile for me may be the tension in an elastic band; draw it too tight (very adversarial, contract driven arrangements between procurer and provider) and the tension gets too great, with the risk of the band snapping. Have it too loose (we're all mates together, and there's no way they can take our business away from us), and it can't keep anything together. A degree of tension that keeps everyone on their toes is what is required, but it all presupposes proper commissioning, with real accountabilities, and as little political and media contamination as possible.
Guess I'll just carry on dreaming...