‘Dependable care in difficult times’ is the theme of 2010′s LMCs conference in London on Thursday and Friday.
Team GP/Healthcare Republic will be reporting live and you can read all the news that matters from it here on Healthcare Republic at healthcarerepublic.com/lmcs.
It depends on who you speak to.
At a National Association of Primary Care (NAPC) event on practice-based commissioning last night, the DoH was keen to show off statistics revealing that GPs believe PBC is beginning to have an impact. Comments from the floor, however, suggested this brave new world was not a reality for many of the clinicians present.
Gary Belfield, the director of the DoH’s commissioning and system management directorate, said the department’s quarterly survey of practices’ views on PBC showed that 60 per cent were actively involved in PBC and increasing numbers felt that it was making a demonstrable difference to patient care.
Throughout the evening, however, a number of GPs begged to differ. Whether it is problems with getting hold of indicative budgets, issues with IT, a lack of support from PCT managers or PCTs unable to get past their concerns about possible conflict of interest if PBC consortia are commissioning services from GPs, it seems the problems surrounding PBC are still legion.
However, it was also clear that where PBC groups are well organised, enthusiastic and have supportive PCTs, PBC is starting to have a positive impact on patient care – and the advent of integrated care models could further enhance this.
This is why it is more important than ever that PCTs understand PBC, are able to work effectively with PBC groups to encourage and foster innovation and, when push comes to shove, will back new ways of working.
The DoH is finally working to address this. Its recent push on PBC stressed the importance of clinical leadership, and PCTs will now be subject to assessment from PBC groups.
PCTs will not be able to reach level 2 of World Class Commissioning without strong clinical involvement and support for PBC, or unless they provide management and financial information and support, swift budget-setting and decision making and local incentive schemes.
It is about time that PCTs were held to account on this. But will this help boost uptake of PBC? And, in fact, is PBC the best way to foster innovation and improve patient care?
We’d be interested to hear about your experiences of PBC – you can comment below.
When practice-based commissioning launched in 2005 it was instantly hailed as the solution to all the NHS’s ills in England.
The term ‘PBC’ quickly slipped into the DoH’s lexicon of acronyms, as ministers claimed it would unleash innovation among frontline staff, giving them the opportunity to shape how services were delivered. This, they said, would improve patient care and save huge sums of cash.
So here we are in 2008 and little progress has been made, according to a report published today by the King’s Fund. The think tank says that in some areas PBC has completely ground to a halt.
This is not that surprising, considering that when the policy was launched there was little indication of how it would actually work in practice. There was an idealistic vision of a future utopian health service, but little about the nitty-gritty of actually achieving it.
The DoH, just embarking on its mission to decentralise the NHS and devolve decisions/any accountability to local trusts, left it up to PCTs to decide how things would work. This, coupled with some very vague overall aims and objectives, clearly made progress impossible.
Then there was the issue of ‘indicative budgets’. When PBC launched, the NHS was in the grip of huge financial deficits. PCTs were looking to claw back funds from wherever possible, so it is not surprising that GPs were wary about whether they would ever see the benefits of any money they saved.
Indeed, the King’s Fund is recommending that government must give real budgets to commissioning groups if it is serious about getting PBC off the ground. This is a sensible idea, and would provide a proper incentive for commissioning groups, as is the idea to develop a ‘matrix’ model that acknowledges the different levels of commissioning.
It is hard to argue against the sentiments behind PBC. Giving GPs and other frontline staff including nurses the ability to redesign services is surely to be encouraged. Clinicians have a much better idea about how services can be improved than office-bound managers and number crunchers at the PCT and this, therefore, means better care for patients.
More needs to be done to make PBC work. The DoH needs to go back to the drawing board and come up with a plan to move things forward. As the King’s Fund points out, there is enthusiasm for local commissioning out there, but it is dwindling. It would be a real shame if that was lost and PBC was consigned to the DoH’s ‘failed policy’ scrapheap.
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