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Government sets out new vision for practice-based commissioning

6 March 2009

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A renewed vision for practice-based commissioning (PBC), and how it relates to world class commissioning, was unveiled this week by the Department of Health (DH).

In the DH’s new vision, developed in collaboration with clinicians, PCTs and SHAs, clinicians and health service managers will combine their expertise to bring about improvements in local health by investing in better quality, better value, and better-designed health services.

The NHS Next Stage Review published last summer committed to reinvigorating PBC. The new vision confirms the direction of PBC as providing a pivotal role in empowering healthcare professionals to drive world class commissioning by having a stronger say in shaping the health and healthcare of local populations in partnership with PCTs.

Health Minister Lord Darzi (pictured) said: “This new vision goes a long way to set out the roles of practice-based commissioners and what they should expect in return.

“Successful PBC will be characterised by clinicians, including GPs, community nurses, allied health professionals, pharmacists and secondary care clinicians engaging in the continuous cycle of reviewing the needs of their community, how resources are used and the services delivered for patients.”

This was welcomed by the chairman of the NHS Alliance, Dr Michael Dixon, who said: “It’s great to see this firm DH reminder that world class commissioning depends almost entirely on PCTs engaging and involving their frontline clinicians through PBC.

“This confirmation and reinforcement should dispel any doubts about whether PBC is here to stay – it is. This must now mark the end of discussions of the role of PBC, and the start of the real action throughout the English NHS. It’s really very simple: no PBC, no WCC.”

Julie Wood, director of the NHS Alliance PBC Federation, said: “We hope this will be a turning point in the development of PBC. The difficult economic conditions make a step change in the development of successful commissioning even more important than ever.

“PBC can deliver: it’s time to give PBC widespread support and proper information and resources, which this new publication should help”.

Nick Goodwin, Senior Fellow at healthcare think tank The King’s Fund, said: “PBC has yet to deliver more effective services across the country, but today’s guidance marks an important next step in its journey to achieving this.

“We must now overcome the many barriers preventing GPs and other clinicians from using PBC effectively. While the new guidance provides few details on how PCTs might address these barriers, it does make PCTs and SHAs directly accountable for the quality of support needed to make PBC a reality.

He added: “If PBC is to work the whole process needs significant investment. It will be essential to demonstrate to clinicians that PBC is a professionally run operation that rewards them appropriately for their leadership and does not tie them into a partnership model where PCTs call the tune.

“If GPs do not get the professional support that is required, or if they are not given the freedom to lead, partnerships between GPs and their PCTs will continue to be dysfunctional and adversarial. What is welcome [in the new DH guidance] is the clarity it provides on the support GPs are entitled to.”


NHS Alliance

King’s Fund   

Do you welcome the government’s vision for PBC? Your comments (terms and conditions apply):

“No. It seems so pointless to fund this mechanism for change when it already exists within the PCT management structures. Had an atmosphere of honest collaborative working, rather than cloaked double standards we have become accustomed to, been developed, primary care would be in a happier state than it is today. The first-class care it already delivers would have become an example to others and doubtless it would be financially much more efficient” – John Venner, West Sussex

“No I don’t. It is flogging a dead donkey. GPs have neither the time, inclination or skills to be health comissioners and the PCTS have squandered any goodwill we originally had by wasting so much of our time in fruitless meetings. I am heartily sick of the whole of PBC and am fervently hoping it will die a natural death so we can concentrate on seeing and treating patients” – Jonathan Heatley, West Sussex