23 November 2007
A flagship government policy aimed at encouraging GPs to shape local NHS services through a beefed-up commissioning role is struggling to take off, the Audit Commission has found.
Practice-based commissioning, where GP practices are given an indicative budget to commission the services they want, has had little impact so far.
'The redesign of services and their transfer from secondary to primary care had yet to gather pace,' according to the commission report published on November 22.
It found 'some progress' had been made at the 16 primary care trusts it visited but that practices' engagement with the scheme was variable. 'PBC is largely being led locally by enthusiastic practices working with supportive PCTs,' the report says. 'The quality of the underpinning financial infrastructure was also variable, with many practices unclear how their budgets had been set, or how financial risk was to be managed.'
Arrangements for GPs to use savings generated by PBC were 'still theoretical, unclear or criticised', it adds. Reconfiguration of PCTs had also 'significantly affected' the development of PBC.
Commission chief executive Steve Bundred said: 'Practice-based commissioning 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.'
Dr Michael Dixon, chair of the NHS Alliance, said: 'PCT and practice commissioners have been blinded by lack of timely, usable information – and straitjacketed by national targets, not least reducing inherited deficits. On top of that, they've been spun around in circles in the name of reorganisation.'
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