21 November 2008
By Tash Shifrin
The government's flagship practice-based commissioning policy, designed to let GPs shape local NHS provision, is 'not operating effectively' and has stalled completely in some areas, the King's Fund think-tank has warned.
Under PBC, established in 2005, GP practices are given an indicative budget to commission the services they want. But in a report published on November 20, the King's Fund said progress on the scheme 'has been slow', with few PBC-led initiatives.
It added: 'There seems to have been little impact in terms of better services for patients or more efficient use of resources.'
The two-year study echoes findings from a Department of Health survey of GP practices released earlier this year.
The King's Fund noted that doctors had received almost £100m in incentive payments alone under the scheme. But its report said: 'Where initiatives have been developed, they have tended to be small-scale, local pilots focusing on providing hospital services in community settings. Few practice-based commissioners have taken an interest in wider commissioning activities.'
PBC was 'clearly not operating effectively', the think-tank said, and 'without significant redesign, the policy will stagnate'.
Report co-author Nick Goodwin, senior fellow at the King's Fund, said: 'As a policy established to pump-prime the transition of care out of hospitals by investing in alternative care in local communities, it has so far failed due to a lack of real investment, leadership, ambition and drive.'
A new approach to commissioning was needed, the report argued, with primary care trusts maintaining responsibility for strategic commissioning but devolving real budgets for specific services to GPs and groups of practice-based commissioners.
The report was welcomed by primary care organisations. Dr Mike Dixon, chair of the NHS Alliance, urged: 'Policy-makers, take note.' The government should 'performance-manage the degree to which guidance is carried out', with strategic health authorities held to account for the success of PBC in their areas.
PFnov2008
