Practice Based Commissioning Survey

November 2008 – January 2009

NAPC conducted a review between November 2008 and January 2009 of the current progress in relation to the implementation of Practice Based Commissioning (PBC).

Three methods were used to collect ‘soft intelligence’:

  • E-mail survey of NAPC members
  • Exit questionnaires following Foundation Commissioning Programme events (approximately 200 delegates at each of the two events)
  • Six small regional evening seminars (approximately 30 delegates).

The findings are categorised in three main areas:

  • Barriers to implementation
  • Successes
  • Solutions

Barriers

  • GP workload
  • GP morale
  • Lack of GP champions
  • PCT reluctance to support PBC – NHS Managers have an inherent resistance to GPs driving clinical change and managing budgets
  • Poor quality data and financial information
  • Slow approval of business cases
  • Failure or severe delays in releasing efficiency gains
  • Block contracting
  • Secondary care providers dictating service redesign
  • Conflict between PCT commissioning and provider functions

Successes

  • Self-determined membership and structure of PBC consortia proved the most successful models, particularly where supported by PCTs and employed PBC CEO/team or consultancy services;
  • Clinical ownership of service redesign leading to more rapid implementation and sustained provision;
  • IT systems developed to support PBC commissioning;
  • Understanding of ‘willing provider’ model reduces need to tender and rapidly improves choice in PCT localities.

Solutions

  • PCT engagement essential to success of scheme. Real performance management of PCTs where PBC failing to thrive;
  • Current total budget and timely financial and clinical data should be made available to practices;
  • Medical Directors should not be seen as voice of local General Practice;
  • Support for PBC management costs;
  • Refreshment rather than reinvention of scheme.

Dr Johnny Marshall, Chairman of NAPC, commented: ‘The future of PBC is now in the balance, resting with policy makers at the Department of Health.  With the correct levers to refresh the scheme, coupled with engagement on the part of General Practice, there is no reason why we should not see a modernisation and transformation of health services both in primary and secondary care to meet today’s patients’ needs’.

NAPC’s President, Dr James Kingsland, continued: ‘The barriers and solutions to the successful implementation of PBC have remained largely unchanged in recent years.  Whilst there has been progress towards the adoption of PBC at practice level, with pockets of good practice identified around the country, there still remains a significant tranche of General Practice which is either disengaged or disenfranchised.  We look to the Department of Health to seek the support of leading organisations, such as NAPC, in the scheme’s future roll-out and success’.