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PBC will be “expensive failure” if GPs not given more power, say LMCs

17 June 2008

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GPs from across the UK voted overwhelmingly in favour of a motion warning practice-based commissioning (PBC) was “doomed to be an expensive failure” unless GPs were given more power, at the Local Medical Committee (LMC) Annual Conference on Friday (13 June).

The motion, proposed by Cornwall and Isle of Scilly LMC and put forward by GP Dr Shelagh McCormick, said “PBC is doomed to be an expensive failure unless GPs are actually allowed to exercise choice in commissioning services on their patients’ behalf”.

GPs at the Conference also deplored the “widespread lack of enthusiasm and support for PBC by PCTs”.

“What GPs are able to commission is limited by the existing infrastructure,” said Dr McCormick, who said that currently “PBC doesn’t allow practices to do what they want to do”.

Her comments echoed the response from a MiP survey of more than 600 practice managers, in which 65% said inadequate resources were available to support PBC, and nearly 30% blamed a lack of co-operation from their PCT for preventing further involvement.

Dr Nigel Watson, a subcommittee chairman of the GPs’ Committee (GPC), defended PBC, insisting there are many instances where the policy is working. “PBC failure is not inevitable, but is down to PCTs, not GPs,” he said.

“PBC is not going to go away,” he added.

However, one GP told the LMC conference that PBC was “one small fish in a sea of barmy political initiatives” and “a waste of clinical time”. Another described PBC as “PCT-based commissioning. That’s all it is at the moment. PBC is definitely going to fail and GPs are going to be blamed for it.”

Another GP, Dr James McMichael from County Durham LMC,  proposed that GPs be given “real PBC budgets”. This, he said, would mean “we could really get the job done and vastly benefit our patients”. However, in response Dr Watson warned that there were “huge risks” in giving practices whole budgets.

Your comments: (Terms and conditions apply)

“At the Management in Practice conference in Manchester last week, PBC was one of the topics covered. As chair, I was able to ask the audience who was involved in PBC by being  part of a consortium or other arrangement. The majority of attendees showed that they were.  However, when the same group were asked if they felt that they were directly involved, the response was minimal. This highlights the fact that managers do not feel empowered to make PBC work effectively as it could. I do agree that for many, it does still appear to be PCT-based commissioning. Many PCT’s are only just now recruiting commissioning staff. I think the key is to devolve actual budgets to those that are directly responsible for commissioning the services and allow them to make direct  choice of the types and level of service provision. A practice managers role in this process is essential and needs to be recognised sooner than later” – Steve Williams, London