This site is intended for health professionals only

Practice-based commissioning: where are all the nurses?

A survey carried out in 2005 by the NHS Alliance and Primary Care Contracting identified that it was mainly GPs and practice managers who were engaging in practice-based commissioning (PbC), with limited involvement of other healthcare professionals.(1,2) So has this situation changed?

PbC is about engaging practices and other primary care professionals in the commissioning process to develop innovative, high-quality services for patients. Through PbC, frontline clinicians are being provided with the resources and support to become more involved in care, deciding how that care should be delivered, where and by whom.

PbC gives clinicians greater freedoms and flexibilities to tailor services to the needs of the local community. However, as nurses it is often difficult to negotiate time and resources to become involved at this level. Have you overcome this and if so how? It is also improtant to recognise and identify the education, training and development needs of those who wish to become involved.

Through PbC the quality and choice of services will improve. Patients will benefit from more services being provided with greater convenience in the community. In particular, patients with long-term conditions will be able to benefit from more personalised care.

The Minister of State for Health, Norman Warner, says, "Practice-based commissioning gives primary care professionals more freedom to innovate and reshape the boundaries between primary and secondary care. It allows them to look critically at all of the care pathways that patient's and users follow. If there is an alternative that is better for the patient and better for the NHS, then PbC provides the basis on which they can change the way that services are delivered."

"Hang on a minute," I hear you say. "We've been doing this for years in primary care." Yes you have, and many of the changes that have taken place over the past 20 years have been as a direct result of frontline nurses changing practice and influencing how resources are used and delivered within their communities. Nurses have a proven track record in demonstrating different ways of working, breaking traditional boundaries and being innovative in how healthcare needs are delivered.

Much of the early work on PbC has focused on the essential task of engaging GPs and practice managers. However, the Department Of Health and trusts also recognise the essential role that other healthcare professionals have to play, stating that: "PbC gives practices and professionals the freedom to develop, innovative, high-quality services for patients."

There are immense benefits to involving you in this process, such as:

  • Effective planning, service improvement and development.
  • The NHS will maximise the use of existing resources including knowledge and skills.
  • There will be more opportunities to achieve NHS priorities and targets, including health improvement and better patient-centred care.
  • Your involvement can contribute to a more robust governance structure and process.

So let's consider what those targets and priorities are:

  • 17.5 million people in this country report living with a long-term condition such as diabetes, asthma or arthritis.
  • Coronary heart disease is the single most common cause of premature death in the UK.
  • One quarter of stroke deaths occur under the age 65.
  • Over one million people in the UK with diabetes and rising.
  • The number of people aged over 85 grew by 6% in 2004-05, 10 times the increase in the general population.
  • Obesity is on the increase - if no action is taken a third of all men and a quarter of all women in England will be obese (consider the huge impact this will have on the NHS).
  • At any one time 1:6 adults suffer from one or other form of mental illness.
  • Every year 200,000 people are diagnosed with cancer in England. Every year 12,000 die.
  • Consider these statistics alongside the fact that a quarter of the nursing workforce is over 50, with the figure even higher in midwifery and the community.

Nurses must take time out to consider this massive agenda and how you might address these issues. Use to engage with other frontline nurses, who like you will feel they know very little about PbC but have a wealth of expertise and understanding of primary care and the healthcare needs of patients and their families to really make a difference.

1. Department of Health. Practice based commissioning: achieving universal coverage. London: DH; 2006.
2. RCGP. Toolkit: Quality assuring patient pathways in practice based commissioning. London: RCGP; 2006.


Primary Care Contracting

NHS Alliance

Department of Health

Cheshire and Merseyside Partnerships for Health

Your comments: (Terms and conditions apply)

"We are now part of a consortium which does not want practice nurses on its board. Obviously we are only here to provide the GPs with vastly inflated salaries." Name and address supplied

"An excellent blog. It is true that we have many innovative nurses working in practice and now is the right time for them to come forward and get involved with PbC and perhaps not wait for practice-based commisioners to make all the decisions on how healthcare is delivered." Name and address supplied

"Lots of community nurses are unable to take part. Doctor consortiums want to employ nurses already employed by PCTs, thus changing their roles and working contracts. This has brought fear for jobs and positions, as people leave. The GPs are taking over the budgets and employing their own staff causing a disruption to continuity of care in the community. They want nurses to work across huge practice areas to save money, not  improve quality. In areas where nurses work across huge demographic areas there is a lack of continuity and delayed healing and no one to take full responsibility for the patients. Patients often do not see the same nurse twice." Name and address supplied