Although practice-based commissioning (PBC) receives widespread support among the main political parties and NHS stakeholder groups, implementation of this policy has been slow. The NHS now boasts 'universal coverage' of PBC but in practice this means it has created an environment in which PBC could flourish rather than one in which it is flourishing. This paper considers the current state of PBC implementation and how it might be driven forward within the NHS. Drawing on the results of a 'straw poll' of GPs and practice managers, the paper outlines a course of action that the NHS could adopt to move PBC from a good idea to effective practice. [Introduction]