In a government survey, more than half of practices rate the quality of managerial support for practice-based commissioning (PbC) provided by their primary care trust (PCT) as “poor”, with 26% assessing it as being “very poor”.
The Department of Health (DH) has commissioned an independent quarterly practice survey, covering a sample of practices from each PCT, in order to get feedback from practices on their perception of the support offered by their PCT and on the clinical and financial engagement of practices with PbC.
While only around a third of practices rate the quality, format and frequency of information provided by their PCT as being good, most practices nonetheless support PbC as a policy: 57% of GPs said they are supportive, while 22% were neutral. Only 8% strongly oppose the policy.
The survey also found that:
- A third of practices have commissioned one or more new services through PbC.
- Less than half of practices have agreed a commissioning plan with their PCT.
- While 56% of practices received an indicative budget from their PCT, most of these believe it has yet to make a difference to the way the GP practice operates.
- 37% of practices said it was too early to tell whether PbC has improved patient care. However, 31% said that PbC had not improved care and only 13% said that it had.
- 72% of practices say they have a good relationship with their PCT.
The survey is part of a group of indicators that will be assessed together to give a picture of PbC implementation.
In response, the NHS Alliance issued a statement saying: “The survey reveals a worrying gap between practice and PCT perceptions.
“A third of practices say they still do not have an indicative PbC budget. Yet according to PCT returns, virtually all practices have been given their budget.
“The essential ingredients are always the same. Good relationships between the practices and the PCT, based on a clear vision and aims for PbC, plus management support with good quality financial and activity information. A new NHS Alliance publication: The PBC recipe book, due to be published next month, will support this.
“However, where there is a negative culture and confusing information, poor results follow. A small number of PCTs may have been reluctant to get behind PbC. The Alliance is confident that will change.”
NHS Alliance PBC lead Dr David Jenner says: “There is wide agreement that we have the right policy – and there are areas where it is already working well. Yet in other places, PCTs and strategic health authorities are in denial over real problems with implementation. If they continue to maintain the mistaken belief that all is well, PbC will fall apart.
“PbC must be made a headline priority. A critical issue is information at practice level. The Secondary User Service (SUS) is not fit for purpose in its current form and needs substantial improvement.
“We are looking at a moving picture and are confident of seeing improvement in the next quarter’s results.”
“The apparent success of PbC has been created by PCTs getting their practices to sign up to phased enhanced services payments. By making such payments, it has created a illusion of national uptake, but in reality some PCTs have done very little to promote successful PbC in their area. Others have been more actively engaged, but the feeling is that very often the necessary commissioning skills are not widely available at PCT level. In some ways, the new Commissioning Support Framework will address some of these issues, but isn’t it disappointing that the government feel the need for these services? Is this actually an indication that PCTs do not have the necessary skills to implement and support PbC fully? If this is true, then this will explain why there has been a slow uptake in some areas. In order to manage commssioning effectively, timely and accurate information is needed. There still seems to be a paucity of reliable information available, and very often this information can be anything up to three months behind real-time reporting. Iron out these snags and we just might start effective commissioning for health improvements” – Steve Williams, London