There is growing enthusiasm among GPs and Primary Care Trusts for Practice Based Commissioning but a lack of communication from the centre is proving to be a big obstacle, according to a report from the NHS Alliance. It is based on a series of 20 workshops organised by the Alliance, Medical Management Services (UK) and AstraZeneca. More than 2,000 delegates attended the sessions, two thirds of them representing GP practices and a third from PCTs.According to today’s report the delegates felt there was increasing enthusiasm for practice based commissioning but lack of communication by Strategic Health Authorities and PCTs is presenting a major problem. Information from PCTs was typically poor, in the wrong format or did not exist at all with a majority of practices reporting that they were still waiting for their indicative budgets.
GPs are also sceptical that they will receive savings resulting from practice based commissioning and they do not see Directed Enhanced Services payments as worthwhile incentives. Many practices do not anticipate any return from their effort and time.
Primary Care Trusts report that they are unable to commit the necessary resources to the implementation of practice based commissioning because of the current focus on deficits and restructuring.
The NHS Alliance is recommending that for PCTs to progress the system effectively, they need to make clinicians from all professions integral to their structures rather than using them on a consultative basis. That, it says, may need clear direction from the Secretary of State and the Department of Health. At the same time the mechanism for shifting funds from secondary to primary care needs to more transparent.
The Alliance also wants deficits to be discussed openly, with clarity about how they will be addressed and it says PCTs and SHA should separate commissioning planning from provision planning. It also stresses that clinical leadership is vital to strategy at PCT and cluster level and that more practical help from PCTs is essential for the effective development of practice based commissioning.