GPs committed to making practice-based commissioning work but lack of support threatens key NHS reform, says new poll

One of the government's central health policy reforms to devolve greater power to GPs and deliver higher quality services to local communities may fail to improve patient care unless GPs and others in primary care receive much greater support from primary care trusts (PCTs).

That is one of the key findings of a small sample poll of GPs and practice managers published today by the King's Fund and the NHS Alliance. Based on the responses of more than 250 GPs and general practice managers, the poll reveals a strong commitment to making practice-based commissioning (PBC) work, with almost three quarters of respondents (73 per cent) saying that they are firmly committed to the policy.

But despite their ongoing support for the reform, primary care professionals identified several barriers that stand in the way of them becoming effective practice-based commissioners. More than a third (39 per cent) reported a lack of support from their PCT as a problem, while nearly a quarter (23 per cent) felt that financial constraints and short-term thinking were preventing implementation. Excessive bureaucracy, meeting national targets, and the turmoil of structural reorganisations were also cited as major barriers.

As a result of these early difficulties, 53 per cent of respondents stated that PBC had so far failed to improve the quality of patient care to date. However, more than half of respondents said that they were optimistic about their ability to deliver improvements to patients next year.

Other key findings of the poll include:

  • Only 3 per cent of respondents felt that their PCT involves them in strategic planning to a 'great extent' and 21 per cent to 'some extent'.
  • A third (33 per cent) said that the support given to them by their PCT was 'poor' with only 30 per cent considering it 'quite good' or 'very good'.
  • Only 4 per cent found their PCT 'very responsive', but 19 per cent said that their PCT was 'not at all' responsive to issues raised by them.
  • More than two-thirds (70 per cent) said that they had not agreed a budget for PBC with their PCT for the last financial year (2006/7). Of those who did have a budget, just under 60 per cent did not understand how it had been set.

Report co-author Richard Lewis, Senior Fellow in Health Policy at the King's Fund, said:

'This small survey provides a valuable insight into the views of the general practice front line. The reality is that many PCTs see practice-based commissioning as something that needs to be done alongside many other targets. We should be optimistic that PBC can deliver better care to patients and more cost-effective services. But this reform may fail if PCTs do not provide GPs and others in primary care with the right support. Above all, practice-based commissioners need sound information and proper budgets if they are to be effective in their new roles.'

Fellow co-author Dr Michael Dixon, Chair of the NHS Alliance, added:

'This survey reveals a new confidence and optimism among front-line GPs and practice managers. They are convinced that practice-based commissioning will deliver better health and care for their patients. The rest of the NHS must now show an equally solid commitment to helping them succeed.'

The findings are published in a joint King's Fund and NHS Alliance report, Practice-based Commissioning: From good idea to effective practice. The report says that there are reasons to be optimistic that PBC will deliver benefits to patients, such as lower rates of hospital admission, lower prescribing costs and innovative primary and intermediate care. But it concludes that there are a number of practical challenges to overcome first if PBC is going to be effective, such as ensuring GPs have access to accurate and timely data about costs and hospital usage and keeping front-line clinicians engaged.

The report makes several key recommendations to ensure that PBC is implemented consistently across the health service, including:

  • PCTs and practices should ensure that each practice has a mutually agreed budget; the right information presented in a useful way and a clear plan of how to use it; support to carry out PBC in terms of people, resources and protected time for clinicians; and an incentive scheme that encourages maximum input from practice-based commissioners.
  • Ministers, the Department of Health and strategic health authorities must continue to articulate the importance of PBC and ensure it is seen as the heart of the NHS commissioning function.
  • Practice-based commissioners and front-line clinicians need to be more involved in strategic commissioning as co-authors of the Local Development Plan (LDP).
  • PCTs together with practice-based commissioners should produce an annual report that itemises the changes to patient care or local health that have come about as a direct result of PBC.
  • PCTs should consider establishing an 'innovation risk fund' that can be called upon to underwrite the risk of innovative PBC plans that might otherwise be put on hold in a risk-averse environment.

Notes to editors: 

Notes to editors

  1. For further information or interviews, please contact the King’s Fund press office on 020 7307 2585, 020 7307 2632 or 020 7307 2581 or the NHS Alliance press office on 01246 410707. An ISDN line is available at the King’s Fund for interviews on 020 7637 0185.
  2. The report is based on a brief questionnaire, which was emailed to more than 600 members of PBC and practice management networks run by the NHS Alliance. A total of 257 responses were received. The questionnaire is not a representative sample and both the King’s Fund and NHS Alliance do not claim that the results necessarily represent the views of the wider GP and practice manager community. However, the findings do provide a valuable insight into the views of the general practice ‘front line’. Of those who responded, 70 per cent were practice managers and 25 per cent were GPs.
  3. Practice-based commissioning (PBC) is the devolution of commissioning roles from PCTs to general practice teams, together with financial accountability for ‘indicative budgets’ (although practices manage their use of resources, formal financial accountability remains with the PCTs). The Department of Health has identified a number of objectives to be delivered through PBC: a greater variety of services; services delivered by a greater number of providers and in settings that are closer to home and more convenient to patients; more efficient use of services; and greater involvement of front-line doctors and nurses in commissioning decisions.
  4. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; conferences, seminars and workshops; publications; information and library services; and conference and meeting facilities.
  5. The NHS Alliance is the independent body that represents primary care. Its membership includes PCTs, GP practices and other primary care organisations, alongside individual clinicians, managers and non-executives. Its multi-professional base means it is the only organisation that can bring PCTs and practices together. It has twelve active professional networks for practice based commissioners, PEC chairs, chief executives, non-executives, primary care providers and more.