Practice-based commissioning

Practice-based commissioning is a key strand of recent NHS reform policy in England, alongside Payment by Results, patient choice and enhanced competition between providers. The policy puts commissioning powers directly in the hands of GPs, giving them more decision-making power over NHS resources to design and deliver new services or to commission others to do so.

The key objectives of practice-based commissioning are to:

  • improve clinical engagement
  • provide better quality, more convenient services for patients
  • bring about more efficient use of resources.

Although the policy has been fully in place since 2005, it is only slowly bedding in and little is known about its impact on health economies. This project seeks to fill that knowledge gap.

The key questions that we are seeking to answer are:

  • how is practice-based commissioning being implemented?
  • what is the impact of the incentives that practice-based commissioning introduces on the clinical and commissioning behaviour of GPs and the pattern of services they put in place to meet their patients’ needs?

In answering these questions, the research seeks to meet four key objectives:

  1. To build a picture of the current state of practice-based commissioning with respect to practice engagement and the governance structures that have been put in place.
  2. To identify to what extent practice-based commissioning is perceived to be a powerful lever to achieving the local and national goals intended.
  3. To identify the most effective models and ways of working and to develop a typology of factors that help and hinder the development of practice-based commissioning.
  4. To identify any impact on service utilisation, referral patterns and other GP behaviour.

Four primary care trusts have been selected as case study sites, and key personnel in the sites (including primary care trust staff, a sample of GPs/practice managers and secondary care staff) are being interviewed in two rounds. The first round took place during summer 2007 and the second took place in early 2008.

The study has been designed to offer an opportunity to measure the speed of progress with implementation and development, and is due to be completed in autumn 2008.

For more information about the project, please contact Natasha Curry.