In March 2011, an informal programme was set up by a consortium of strategic partners to the Department of Health, led by Shaping Our Lives and Disability Rights UK, to initiate, take stock of and further develop local work on ‘user-driven commissioning’. As part of this programme, local pairs of commissioners and user projects were brought together to pool their personal budgets and deliver peer support as an integrated element of cross-sector care and support pathways, giving Disabled and older people the opportunity to use their insights gained as micro-commissioners to inform and push for re-commissioning (from block to spot). This report sets out the background to and results of this national programme, culminating in a roundtable event in London in December 2011 (and developing further since).