Approach
Our two-year investigation into the implementation and impact of practice-based commissioning (PBC) assessed progress against the policy’s three main objectives and identified barriers that were limiting its success.
The study was a qualitative project based on semi-structured interviews in four case study sites. It was not designed to provide a representative picture of the state of practice-based commissioning in England, but rather to provide an in-depth look at its implementation and impact locally. The research tried to identify factors that facilitated, and factors that were barriers to, the implementation of PBC.
Conducting the case studies
We chose sites that were relatively advanced in implementing PBC, as we believed that more could be learnt from studying areas that had made the most progress. The following criteria were used in creating a long-list:
- a high percentage of GPs had taken up the incentive payment for PBC activity by October 2006
- the PCT had not been reconfigured in October 2006.
From the long-list of sites that met these criteria, we then made a further selection to ensure a mix of financial situations and of rural and urban locations. The four sites selected included two in deficit and two in balance/surplus; one inner-city area, two mixed urban/rural areas and one suburban area.
We undertook in-depth interviews with a range of primary care trust (PCT) staff, hospital staff, GPs and practice managers to explore:
- uptake of PBC across practices and motivation for getting involved
- development of local governance and accountability arrangements to support and control PBC
- relationships and communication between the main parties involved in PBC
- identification of PBC priorities and the key impacts/achievements of PBC to date against local and national objectives
- interpretation of PBC policy and how it's likely to develop in the future.
Two rounds of interviews were conducted, between six and eight months apart. This enabled the research team to detect any changes or progress in terms of the development of PBC, the attitudes towards the policy, or the relationships between the key individuals.
We also gathered additional documentation.
Expert seminar
To provide external validity to our findings, and to ascertain how representative the findings from our case study sites were, we held an expert seminar, inviting policy-makers, GPs involved in PBC, representatives from PCTs, and academics. The seminar helped to highlight barriers common across the country, and to clarify the options for the future of PBC as a policy.
