Practice-based commissioning (PbC) is making limited progress, according to a new Audit Commission report.
The Commission looked at how the financial management arrangements supporting PbC are working, the incentives for GP practices to engage with it and the obstacles to its introduction.
Steve Bundred, Chief Executive of the Audit Commission, said: "PbC offers potential benefits to patients but won't take off unless the NHS gets the financial infrastructure right. Clear and sustained leadership for this policy is also needed if it is to deliver.
"At the moment, patients are losing out because they are not benefiting from the service improvements PbC can provide. Our recommendations are designed to help the Department of Health, primary care trusts (PCTs) and practices achieve that potential."
The report found that the factors central to success were:
The report found that few areas had all these factors in place. Many had been hampered by reorganisation. Where there had been some success, it was largely the result of a small number of enthusiastic practices working closely with supportive PCTs that recognised the commitment involved.
In these places, the Commission says, PbC was starting to have an impact on managing referrals, as GPs understand the financial consequences of the clinical decisions they make.
The NHS Alliance responded to the report, saying it provides important lessons for practice-based commissioners and PCTs, but that it "also demonstrates acute failings in the essential infrastructure that should be in place to make PbC possible."
NHS Alliance Chairman Dr Michael Dixon said: "PCT and practice commissioners have been blinded by lack of timely, usable information – and straitjacketed by national targets, not least reducing inherited deficits. On top of that, they've been spun around in circles in the name of reorganisation. Did anyone really expect PbC to work in that environment?
"Despite these problems, PbC is working well in some areas. There are individual practices and PCTs who have improved patient care and achieved substantial savings at the same time. Invariably, these achievements depend on respect and trust between local clinicians and PCT managers. It is that partnership that is crucial to the future for NHS commissioning.
"PbC has the potential to transform the health service. Providing the Audit Commission's advice is followed, that can become a reality very soon."