Commenting in response to new guidance published today by the Department of Health on the future of practice-based commissioning, Nick Goodwin, Senior Fellow at The King's Fund, said:
'Practice-based commissioning (PBC) has yet to deliver more effective, more responsive and better value-for-money services across the country, but today's guidance marks an important next step in its journey to achieving this. The vision outlined by the government today confirms its commitment to PBC, its strategic importance within the wider commissioning agenda, and how after four years of relative inaction they will support GPs and other clinicians to make this work.
'The key challenge now is turning PBC from something that primary care trusts (PCTs) 'must do' towards an approach that really leads to service improvements on the ground. This will require a step-change in capabilities and mindsets, as well as much greater involvement from clinicians in commissioning. But the potential prize is worth the effort – we know that PBC has the potential to help GPs plan and deliver better and more accessible services to patients, provide more choice of treatment and to use financial resources more effectively.
'We must now overcome the many barriers preventing GPs and other clinicians from using PBC effectively – we are pleased that today’s report agrees with our analysis of the major hurdles that continue to impede progress*. While today's guidance provides few details on how PCTs might address these barriers, it does make PCTs and strategic health authorities directly accountable for the quality of support needed to make PBC a reality. This will provide a major boost to clinicians on the front line. Also, plans to support PBC through a £1m pump-priming in external support and a best-practice network may help, but this is likely to be a drop in the ocean compared to the resources that are needed to make it work.
'The guidance helpfully places PBC as a key tool for PCTs to influence and lead strategic service change through commissioning. But if PBC is to work the whole process needs significant investment. It will be essential to demonstrate to clinicians that PBC is a professionally run operation that rewards them appropriately for their leadership and does not tie them into a partnership model where PCTs call the tune.
'If GPs do not get the professional support that is required, or if they are not given the freedom to lead, partnerships between GPs and their PCTs will continue to be dysfunctional and adversarial. What is welcome in today's guidance is the clarity it provides on the support GPs are entitled to. What is now needed is the right mix of ambition, incentives and professionalism that will encourage clinicians to lead the implementation of this important policy – something that has so far proved hard to achieve.'
Notes to editors:
- For further information or interviews, please contact The King’s Fund press and public affairs office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
- The launch of the Department of Health document, Clinical commissioning: our vision for practice-based commissioning, was held at The King’s Fund today (4 March 2009).
- *In November 2008, The King’s Fund published Practice-based commissioning: reinvigorate, replace or abandon?, by Natasha Curry, Nick Goodwin, Chris Naylor and Ruth Robertson. The report represents one of the most significant studies of practice-based commissioning since its introduction in 2005.
- The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.