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PbC “yet to reach its full potential”

23 November 2007

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The government’s drive to give GPs greater financial control and responsibility over the services they commission for patients is making limited progress, according to a report published by the Audit Commission. 

The Audit Commission looked at how the financial management arrangements, supporting practice based commissioning are working, the incentives for GP practices to engage with it and the obstacles to its introduction.

Steve Bundred, Chief Executive of the Audit Commission, said: “Practice Based Commissioning (PbC ) offers potential benefits to patients but won’t take off unless the NHS gets the financial infrastructure right.

“Clear and sustained leadership for this policy is also needed if it is to devliver. At the moment patients are losing out because they are not benefiting from the service improvements which practice based based commisioning can provide.”

In response to the report, Dr Laurence Buckman, Chairman of the BMA’s GP Committee, said: “This report highlights what many GPs have unfortunately known for quite a while – PbC has great potential but that potential will never be reached if Primary Care Trusts (PCTs) continue to block initiatives and fail to support practices adequately. 

“The BMA’s own survey of GPs1 showed nearly a third of family doctors said their Primary Care Trust was either obstructive or uncooperative in relation to PBC.  Two thirds said not enough resources were made available to support the workload.  Is it any wonder that doctors who are initially keen to drive forward PBC find their enthusiasm drained when their efforts to improve services are blocked?”

The Audit Commission

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“When PbC was announced, I would agree that I experienced a genuine swell of interest and participation from GPs. Then came the issue of finance and funding. This was swiftly followed by the now infamous declaration of financial deficits. PCTs were quick to pass the cause of this overspend onto the commissioners (ie the practices) but in reality this was their problem. Why only now do they expect GPs to cut referrals and introduce new packages of care?  Why has the government seen the need to introduce a service framework (from the private sector) to support PCTs in making PbC work. If the necessary skills and acumen were already in place, then perhaps PbC would be more advanced than it is now. Commissioning should have advanced now to be commissioning for health improvements with numerous local models and variations in place. It is true that the process to innovate change has become far too bureaucratic with PCTs being in a position to veto any significant changes to the way services are delivered. I can completely understand why so much early enthusiasm has now been lost. Empower the commissioners to make it work, fund them and provide appropriate support. Otherwise, scrap it from this year’s agenda (again) and make yet another fresh start in April next year” – Steve Williams, London