GPs encouraged by government's vision for practice-based commissioning but barriers still hamper progress

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GPs and practice managers still face familiar barriers when it comes to making one of the government's flagship health policies a success, yet many remain optimistic that practice-based commissioning (PBC) can make a difference to patient care.

This is one of the key findings of a small sample poll of GPs and other primary care professionals published today by The King's Fund and NHS Alliance. Based on responses from more than 320 GPs, practice and PBC managers, the poll reveals that levels of commitment to making PBC work remain high, with just under four-fifths (78 per cent) saying they were firmly committed to the policy.

Many respondents said the government's recent report* on PBC, which attempted to provide a clearer vision for the future of the policy, had contributed to professionals feeling more optimistic, saying they felt it placed clinicians at the centre of successful commissioning. The report's key findings include the following points.

  • Just under three quarters polled (72 per cent) said they felt PBC had the potential to improve patient care in the next two years.

  • This survey suggests that respondents believe PBC is becoming more formalised. More than half (60 per cent) of respondents said there was an agreed governance framework between their cluster or practice and their PCT, while 40 per cent said there was an agreement in place in their PCT to manage conflicts of interest. A major report on PBC published by The King's Fund in 2008** warned that the policy was likely to fail if relationships between practice-based commissioners and PCTs continued to be conducted on a voluntary basis.

But despite their ongoing support for the reform, primary care professionals identified several key issues standing in their way.

  • Over half (52 per cent) said they did not feel very or at all engaged by their primary care trust (PCT).
  • Less than half of all respondents agreed or strongly agreed that they were receiving from their PCTs the support they were entitled to, including data provision, financial advice and management support.
  • Almost a third (29 per cent) of respondents who had submitted a business case said that, on average, it takes 25 weeks or more to gain approval. In almost half of all cases, it takes almost a year for a business case to go from being submitted to patients feeling the benefits from new services.

Report co-author Natasha Curry, health policy fellow at The King's Fund, said:

'This survey shows us some progress has been made, particularly in the formalisation of PBC governance arrangements. However, what is striking is that the same barriers that we identified in 2007 still hamper progress. It is vital that, whatever form PBC takes in the future, primary care professionals and PCTs work closely together to tackle these obstacles head on.

Julie Wood, co-author and director of the NHS Alliance's PBC Federation, said:

'We are pleased to see that commitment to practice-based commissioning is on the increase and that people feel positive about it. We recognise that many issues need to be addressed, particularly regarding engaging clinicians and other health professionals at local level. But the fact that the NHS is heading towards a deep financial crisis makes the case for PBC even more compelling. PBC is the only answer in terms of re-creating a cost-effective NHS through involving clinicians, who directly affect NHS costs, and galvanising local support to sometimes difficult issues of prioritisation.'

The findings are published today in PBC two years on: moving forward and making a difference? The report follows on from a similar survey by The King's Fund and NHS Alliance in 2007.

Notes to editors

  1. 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.
  2. 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.
  3. The NHS Alliance is the only independent body that brings together primary care trusts’ chief executives and other senior managers, doctors and practice managers, nurses, pharmacists and allied health professionals, along with board chairs and members. We are a value-driven organisation, with no political affiliation, which works in partnership with various bodies associated with the NHS to create a progressive health service that is free from the traditional tribalism of single interest groups.
  4. PBC two years on: moving forward and making a difference? is available to download from The King’s Fund and NHS Alliance websites from Wednesday 1 July 2009: and
  5. The survey was sent out via email to the NHS Alliance members’ network as well as to the PBC consortia/practices identified through NHS Networks’ ‘PBC connection’. A response was submitted by 321 people, which compares favourably with the 257 responses received in 2007. Recipients were encouraged to forward on the survey to colleagues so it is not possible to calculate an exact response rate. This survey could be described as a straw poll; it is not a representative sample and we do not claim that the results necessarily represent the views of the wider GP, practice manager and PCT community. However, we do believe that it provides a valuable insight into the views of those most closely involved with PBC. Of those who responded, 45 per cent were GPs and 26 per cent were practice managers.
  6. * Department of Health (2009). Clinical Commissioning: our vision for practice-based commissioning. London: Department of Health.
  7. ** The King’s Fund’s major 2008 study, Practice-based commissioning: reinvigorate, replace or abandon?, by Natasha Curry, Nick Goodwin, Chris Naylor, Ruth Robertson, is available to download from The King's Fund’s website.