01 December 2006
The transfer of hospital services into the community moved a step further this week as the government told primary care trusts to develop local markets with a range of providers.
The Department of Health's latest guidance on practice-based commissioning, published on November 28, said the initiative should be used to redesign services, extend choice and move more care closer to patients.
Practice-based commissioning: practical implementation clears some of the red tape that GPs claim prevents them setting up new services and encourages PCTs to offer practices incentives to meet national priorities.
Health minister Lord Warner claimed practice-based commissioning would help cut waiting lists and promote financial balance. 'PBC gives clinicians the information, levers and incentives to improve services in response to the needs of their patients and local communities,' he said.
The guidance clarifies the need to tender for new services and the use of the payment by results tariff for services moved into the community. Tenders will be needed only if a monopoly is being created — say, if a whole service was being moved out of a hospital and no alternative was available within the PCT's boundary.
However, this should happen in exceptional circumstances only, and PCTs should encourage a range of providers (including GP-owned limited companies).
In a move that will infuriate many hospital trusts, the PBR tariff will not apply to services moved to the community if they meet certain conditions. These are: if the service is provided by a GP or any other clinician employed to provide primary care services; if it is provided in accommodation paid for by the NHS; or if it has been provided in a hospital outpatients department. This will allow practices to undercut the tariff price.
However, the guidance was widely welcomed. 'It emancipates effective PCTs — those who listen to and support their local practices,' said NHS Alliance chair Michael Dixon.
Jo Webber, NHS Confederation deputy policy director, said: 'Only by clinicians and managers working together can we transform care and make sure that patients are treated at the right time, in the right place by the most appropriate health care professional.'
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