Notes to editors
For further information or interviews, please contact The King’s Fund press office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185. Embargoed copies of the report are available.
Practice-based commissioning: reinvigorate, replace or abandon?, by Natasha Curry, Nick Goodwin, Chris Naylor and Ruth Robertson is free to download from The King's Fund website. The report represents one of the most significant studies of practice-based commissioning since its introduction in 2005. The policy was not subject to a trial or pilot phase and a formal evaluation of the initiative has only recently been commissioned by the Department of Health – this is not due to be published until 2010. As a result, the evidence on how practice-based commissioning has influenced the care provided in local communities is limited.
GP fundholding ran from 1991–1997 as a voluntary scheme within which GPs could purchase elective care with a real negotiated budget from health authorities whilst simultaneously managing a prescribing budget. Variations to GP fundholding over this period, such as Total Purchasing Pilots (1994–7), enabled GP practices to extend their responsibility for managing budgets to non-elective care, though in most cases these used indicative budgets as financial responsibility remained with health authorities. The election of a New Labour government ended the experiment with all forms of GP-led purchasing – primarily on the grounds that it increased transaction costs and promoted two-tier access to care.
The Audit Commission estimated that £98 million of incentive payments had been made to GP practices involved in practice-based commissioning in 2006/7 alone. About half was associated with signing up to accepting an indicative budget and the rest conditional on developing local PBC plans (Audit Commission, Putting commissioning into practice, November 2007).
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