In 2007, a straw poll of GPs and practice managers by The King’s Fund and NHS Alliance found that primary care trusts (PCTs) were struggling to put in place the basic building blocks of practice-based commissioning (PBC). Two years on, has PBC moved forward and is it making a difference to patient care? A new poll has found continuing commitment to PBC and optimism about its potential but progress is still hampered by a lack of local vision, a lack of clarity over roles and responsibilities and bureaucratic governance processes. Moving into an era of restricted financial resources, it will become increasingly important for PCTs and practices to work together. Real clinician engagement – underpinned by locally developed visions, structures, agreements and lines of accountability – is key to the development of effective partnership working.