This project completed in July 2009.
In brief
- Practice-based commissioning (PBC) is a government policy designed to give general practitioners (GPs), nurses and other primary care professionals the power to decide how NHS money is spent in their local area. In 2006 we began a research project to assess the progress of PBC in four case study sites in England.
- The policy was introduced in 2005 and is one of the cornerstones of the current health service reforms in England. The government hoped that it would achieve three things:
- better clinical engagement, allowing primary care professionals to develop services for their patients
- better services for patients provided locally
- better use of resources.
- GP practices are given ‘virtual’ budgets with which to ‘buy’ services for their populations, with the real money being held by their local primary care trust (PCT).
- Questions have been raised about the extent to which PBC has been successfully implemented and whether it is achieving its objectives. In 2008 the NHS Next Stage Review acknowledged that PBC had not lived up to its potential, and set out the government’s intention to ‘redefine and reinvigorate’ it.
- Our research has included a series of in-depth interviews with a range of PCT staff, hospital staff, GPs and practice managers. Findings from the case study sites were tested with a group of policy-makers, representatives from PCTs, and academics to find out whether they were representative of the situation nationally.
- Practice-based commissioning: reinvigorate, replace or abandon?, published in 2008, sets out the findings from this research. Assessing progress against the policy’s three main objectives, it identifies the barriers that are limiting its success.The report concludes that implementation of PBC has been slow and that there is an urgent need to harness what remains of GPs’ limited enthusiasm for the policy. If PBC’s modest successes are to be built on, the government must commit to the policy, be clearer about its aims and define where the responsibility for different commissioning decisions should be held.
- Since the publication of the report, the government has released a document setting out its vision for reinvigorating PBC.
