The UK Department of Health's perspective of commissioning is the means by which we secure the best possible health outcomes and the best possible healthcare within the resources made available by the taxpayer.

This article identifies how the commissioning of laboratory medicine fits into the commissioning framework. Laboratory services clearly have an integral role in numerous patient care pathways; however, the laboratory has traditionally been considered as a factory producing numeric results. The focus is now shifting towards a customer-focused service-based provision, ensuring that the appropriate tests are requested, measured and interpreted correctly to optimize patient care. The authors highlight the fact that the commissioning of laboratory services should be based on what it contributes to the care pathway, rather than the number of results that can be delivered at a certain cost.

A total of 152 primary care trusts (PCTs) are now at the centre of the National Health Service (NHS) and control 80% of the NHS budget, equating to around £72 billion in 2007–2008. The authors state that the first goal of commissioning is to establish the PCT commissioners' needs and how the laboratory service can help to meet those needs. This may involve the introduction of new tests or provision of point of care testing as well as maintaining the core features of the existing laboratory medicine service.

Pathology can facilitate the redesign and optimization of patient care pathways, as indicated by recent evidence confirming that brain natriuretic peptide can be used to guide and monitor therapy in heart failure more efficiently than previous methods.

The authors conclude that there is an urgent need to reform the business model, shifting towards ‘service-centric’ as apposed to ‘production-centric’ organizations. Reforms in resource management as well as financial management and business management are required to meet the challenges of commissioning laboratory services.