Purpose - The purpose of the article was to explore the implications of GP commissioning through the lense of complexity theory. The key point that they article attempts to raise is that GP commissioning does imply greater freedom, responsibility and ability to move the English NHS in a more public oriented, locally responsive and public health oriented direction. At the same time, as demonstrated by the Stacey Diagram, it forces GPs into difficult complex situations that lie outside of their traditional skill range and experiences and implores them to deal with a much wider range of actors and institutions that they are unfamiliar with and are well beyond their control.

Design/methodology/approach - This is a discussion paper that explores the recent proposals for GP commissioning from a complexity framework and in particular the 'Stacey Diagramme'.

Findings - the commissioning reforms may represent a healthy organisational transformation of the NHS and over time generate a number of positive outcomes. Nevertheless, with a complexity perspective, one can begin to understand why this reform is so challenging for GPs, and that it will take a whole new range of GP skills and decision-making strategies (and maybe even a shift in the overall GP culture) in order to make it work.

Originality/value - To my knowledge this is the first attempt to use complexity theory to explore the strengths and weaknesses of GP commissioning