This site is intended for health professionals only

Concerns over “persistent weaknesses” of practice-based commissioning

The government’s commitment to “reinvigorate” practice-based commissioning will need more than just extra funding if it's to tackle its persistent weaknesses, warns an editorial published on today.

Practice-based commissioning (PBC) – the system in which family doctors decide which health services to buy for local people – has been a central part of the government’s health policy since April 2005, when interested practices were first entitled to indicative budgets.

Yet nearly two decades of experimentation in the English NHS have provided little evidence that any form of commissioning has greatly affected hospital services, argue general practitioner Stephen Gillam and Richard Lewis, Director at Ernst and Young.

Even the government acknowledges that practice based commissioning is stalling, they add.

Of course, PBC is a work in progress, say the authors. However, all manifestations of primary care commissioning have been beset by common weaknesses. These include a lack of clinical engagement, organisational immaturity, insufficient support from management, limited public involvement or accountability, and lack of information on which to base commissioning decisions.

The right formula with which to tackle these weaknesses remains, as yet, stubbornly out of reach, they write, and this raises the question of whether these deficits are simply intrinsic.

So where do we go from here, they ask? Several “solutions” abound, including a “matrix” model that places different responsibilities at different levels, and the Royal College of General Practitioners’ proposal for practice federations (associations of practices and community primary care teams) to develop expertise.

New “integrated care organisations” are also about to be piloted. These will offer real budgets to practices in return for the responsibility to manage health and population care, and offer the prospect of much stronger incentives for general practitioners and other professionals to shape local services.

PBC is clearly not about to be dismantled, even with a change of government, conclude the authors, but if tangible results remain elusive, evidence based policy makers will wonder whether this patient needs palliative care not reinvigoration.