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Thursday 29 September 2016
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Practice managers optimistic about PBC, but problems remain

Practice managers and GPs still face familiar barriers when it comes to making practice-based commissioning (PBC) a success, yet many remain optimistic that the health policy 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 (1 July 2009) by the King's Fund and the 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 78% saying they were firmly committed to the policy.

Many respondents said the government's recent report, Clinical Commissioning: our vision for practice-based commissioning, 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.

Almost three-quarters polled (72%) said they felt PBC had the potential to improve patient care in the next two years. Sixty percent said there was an agreed governance framework between their cluster or practice and their PCT, while 40% said there was an agreement in place in their PCT to manage conflicts of interest.

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

  • More than half (52%) said they did not feel very or at all engaged by their PCT.
  • Less than half felt they were receiving their entitled support from PCTs (including data provision, financial advice and management support).
  • Almost a third (29%) of respondents who had submitted a business case said that, on average, it takes 25 weeks or more for it 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.

A major report on PBC published by The King's Fund in 2008 warned PBC was likely to fail if relationships between practice-based commissioners and PCTs continued to be conducted on a voluntary basis.

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, Director of the NHS Alliance's PBC Federation, said: "We are pleased to see that commitment to PBC 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 recreating a cost-effective NHS through involving clinicians, who directly affect NHS costs, and galvanising local support to sometimes difficult issues of prioritisation."

NHS Alliance

King's Fund

Related MiP articles:

PBC – why managers should still give it air time!

PBC – assessing the reinvigoration agenda