An Audit Commission report finds that limited progress has been made with practice based commissioning.
Introduced in 2005/06, the idea was to give GPs more freedom and financial power over development of new local services and choices for patients.
The Commission identified a number of key factors for making practice based commissioning work. These included accurate information so GPs could follow progress, development of timely and robust budgets that could be understood by GP staff and enough flexibility for practices to make changes and make savings to benefit their patients.
It also said good governance arrangements were needed for approving business plans and overcoming possible conflicts of interest as was greater sharing of responsibility between primary care trusts (PCTs) and practices on use of resources.
It found only a small number of PCTs had all factors. Reorganisation had created problems for many. A small number of practices were doing well but this was usually due to a few eager and motivated practices working closely with supportive PCTs.
The Commission carried out interviews at 16 PCTs with 3 GPs at each. It asked about local commissioning arrangements and obstacles to implementation. In addition 122 GPs and practice managers were surveyed for views on policy and implementation. The Commission also looked at data from local audit work of PCTs and acute trusts in England.
‘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 if it is to deliver,’ said Steve Bundred, Chief Executive of the Audit Commission.
‘At the moment patients are losing out because they are not benefiting from the service improvements which practice based commissioning can provide.’
Dr Laurence Buckman, chairman of the BMA’s GP committee, agreed. ‘This report highlights what many GPs have known for quite a while - practice based commissioning has great potential but that will never be reached if PCTs continue to block initiatives and fail to support practices adequately.’
A BMA survey of GPs had found almost a third said their PCT was obstructive or uncooperative over practice based commissioning whilst 66% said insufficient resources were made available to support the workload.