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More than half of GPs and practice managers think PbC has failed to improve patient care, finds poll

17 May 2007

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In a small sample poll of GPs and practice managers, published today by the King’s Fund and the NHS Alliance, 53% of respondents stated that practice-based commissioning (PbC) had so far failed to improve the quality of patient care.

The report suggests PbC may fail to improve patient care unless GPs and others in primary care receive much greater support from primary care trusts (PCTs).

Based on the responses of more than 250 GPs and general practice managers, the poll nevertheless reveals a strong commitment to making PbC work, with almost three-quarters of respondents (73%) saying that they are firmly committed to the policy.

But despite their ongoing support for the reform, primary care professionals identified several barriers that stand in the way of them becoming effective practice-based commissioners. More than a third (39 per cent) reported a lack of support from their PCT as a problem, while nearly a quarter (23%) felt that financial constraints and short-term thinking were preventing implementation. Excessive bureaucracy, meeting national targets, and the turmoil of structural reorganisations were also cited as major barriers.

These early difficulties have led 53% of respondents stated that PbC had failed to improve the quality of patient care to date. However, more than half of respondents said that they were optimistic about their ability to deliver improvements to patients next year.

Other key findings of the poll include:

  • Only 3% of respondents felt that their PCT involves them in strategic planning to a “great extent” and 21% to “some extent”.
  • A third (33%) said that the support given to them by their PCT was “poor” with only 30% considering it “quite good” or “very good”.
  • Only 4% found their PCT “very responsive”, but 19% said that their PCT was “not at all” responsive to issues raised by them.
  • More than two-thirds (70%) said that they had not agreed a budget for PbC with their PCT for the last financial year (2006/7). Of those who did have a budget, just under 60% did not understand how it had been set.

Report co-author Richard Lewis, Senior Fellow in Health Policy at the King’s Fund, said: “This small survey provides a valuable insight into the views of the general practice frontline. The reality is that many PCTs see PbC as something that needs to be done alongside many other targets. We should be optimistic that PBC can deliver better care to patients and more cost-effective services. But this reform may fail if PCTs do not provide GPs and others in primary care with the right support. Above all, practice-based commissioners need sound information and proper budgets if they are to be effective in their new roles.”

Fellow co-author Dr Michael Dixon, Chair of the NHS Alliance, added: “This survey reveals a new confidence and optimism among frontline GPs and practice managers. They are convinced that PbC will deliver better health and care for their patients. The rest of the NHS must now show an equally solid commitment to helping them succeed.”

The findings are published in a joint King’s Fund and NHS Alliance report, Practice-based Commissioning: From good idea to effective practice. The report says that there are reasons to be optimistic that PbC will deliver benefits to patients, such as lower rates of hospital admission, lower prescribing costs and innovative primary and intermediate care. But it concludes that there are a number of practical challenges to overcome first if PbC is going to be effective, such as ensuring GPs have access to accurate and timely data about costs and hospital usage and keeping frontline clinicians engaged.

The report makes several key recommendations to ensure that PBC is implemented consistently across the health service, including:

  • PCTs and practices should ensure that each practice has a mutually agreed budget; the right information presented in a useful way and a clear plan of how to use it; support to carry out PbC in terms of people, resources and protected time for clinicians; and an incentive scheme that encourages maximum input from practice-based commissioners.
  • Ministers, the DH and strategic health authorities must continue to articulate the importance of PbC and ensure it is seen as the heart of the NHS commissioning function.
  • Practice-based commissioners and frontline clinicians need to be more involved in strategic commissioning as co-authors of the Local Development Plan (LDP).
  • PCTs together with practice-based commissioners should produce an annual report that itemises the changes to patient care or local health that have come about as a direct result of PbC.
  • PCTs should consider establishing an “innovation risk fund” that can be called upon to underwrite the risk of innovative PbC plans that might otherwise be put on hold in a risk-averse environment.