Practice-led commissioning – which involves primary care clinicians in commissioning care and services – could help meet two challenges. First, it could boost the strength of commissioning. Second, it could harness the talents of clinicians in managing and planning health services. This paper looks at the benefits of practice-led commissioning, and what it could mean within the new NHS structures. It explores the lessons of GP fundholding, total purchasing, and locality/GP commissioning pilots. Finally, it looks at ways of implementing practice-led commissioning, highlighting strategic risks and identifying where practice-led commissioning would be most welcome.