Health Minister Lord Darzi (pictured) has defended any changes to practice-based commissioning (PBC) which are likely result from his review of the NHS.
A report for the Nuffield Trust had said that a major overhaul of PBC was needed if the government's aims were to be met, and said that the practice had so far hampered the provision of secondary care services in the community.
Professor Chris Ham, the report's author, said that a "radical expansion" of PBC was needed and called for GPs to be given "real budgets" to work with.
"What I would hope to see in the Darzi review is a much more radical version of what we call PBC. One that gives GPs more opportunity to control budgets," Professor Ham told the GPs' magazine Pulse.
"We need to give practices real responsibility for deficits, and for PCTs not to constrain the best practices."
But a key adviser to Lord Darzi said the NHS review would "reinvigorate" PBC by transforming data quality and strengthening incentives for GPs. Dr Michael Dixon added that the health minister would be addressing any weaknesses in PBC in his upcoming review.
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"I think Professor Ham is right in his approach. Devolve real budgets to those that have direct responsibility for spending the resources. Create real accountability. By all means put in place the necessary bells and whistles, but to date PBC is being restricted because ultimately PCT's are still trying to retain control. I was recently advised by a PCT commissioning manager that they could not comment about the indicative budget because it was devised by the finance department! One practice who has been in the top 5% in respect of budget performance is again having its activity cut this year, but is being told that it will be given 'a fair share' adjustment if there is no overall deficit this year. Where is the incentive in that type of model? A framework for external support for commissioners has been agreed (FESC) so it is hard to understand why commissioners are still not receiving support from their responsible PCTs. To date I am aware of instances where practices have not received a single piece of management information for the current year. And now it would seem that some PCT's are looking for their practices to provide them the solutions to achieving their targets under the disguise of PBC. Empower the people that can deliver and then perhaps we can realise the potential of local PBC and even the principles of World Class Commissioning" – Steve Williams, London