A parliamentary watchdog has blasted "poor" PCT commissioning and "very variable" PCT management as "striking and depressing".
The House of Commons' health committee also warned that a roll-out of GP-led health centres – or "polyclinics" – without being piloted and without established criteria "has the potential to waste taxpayers' money and be grossly inefficient."
In its first report on the NHS Next Stage Review, the health committee warned that PCTs "lack analytical and planning skills and the quality of their management is very variable. This reflects on the whole of the NHS: as one witness told us: 'the NHS does not afford PCT commissioning sufficient status'. We consider this to be striking and depressing."
The report also cast doubts over the Next Stage Review's plans to reinvigorate practice-based commissioning (PBC), a policy it said had "failed to engage doctors and PCTs". The committee also said the role of PBC in relation to World Class Commissioning by PCTs "remains opaque and needs greater clarification".
Commenting on the report, Steve Barnett, chief executive of the NHS Confederation, which represents over 95% of NHS organizations, said: "The concerns raised by the committee on the ability of PCTs to implement the Next Stage Review are misplaced.
"PCTs have strengthened their commissioning capacity significantly over the last two years and have plans in place to continue this improvement. With hard-won financial stability, new expertise and the world class commissioning programme, we are confident that PCTs can deliver Lord Darzi's vision for the future of the NHS.
Yet Dr Hamish Meldrum, Chairman of Council at the British Medical Association (BMA), supported the committee's findings. "Many doctors are frustratingly aware of the poor level of support available in many PCTs particularly in commissioning new services," he said.
"The BMA has always supported the concept of PBC, as it can offer great benefits to patients, but this potential is too often squandered by the absence of adequate support or creative input from PCTs. Clearly the variable management quality in PCTs, highlighted in the report, must be addressed if patients are to benefit."
Elsewhere, the report said: "We are not convinced by the Department of Health's argument that all PCTs should have a GP-led health centre." It said this should be decided on a case-by-case basis, and national criteria should be set out for PCTs to follow so that benefits and costs of their decisions are known.
The health committee said it was "disappointed that neither the government nor witnesses representing doctors could tell us what criteria should be used to decide whether a PCT needed a GP-led health centre."
The report added: "While polyclinics and GP-led health centres can bring benefits, we are disappointed that the Department [of Health] is introducing them without prior pilots and evaluation. The evaluation of the first five polyclinics in London is yet to be designed, making the collection of baseline data difficult if not impossible and 'before and after' comparison of performance even more difficult.
"It is unclear how this evaluation, which will be commissioned in early 2009, will be used to inform the roll-out of the programme. There is a risk that roll out will precede the results of the evaluation, which has the potential to waste taxpayers' money and be grossly inefficient."
Dr Meldrum said: "The report supports the BMA's view that the government directive – that a GP-led health centre be introduced in every PCT regardless of local need – was short-sighted. It also reiterates our concerns that GP-led health centres have been introduced without proper pilots or evaluation."
Your comments (terms and conditions apply):
"I am sure that the vast majority of practice managers would agree with the findings of this report. There is no doubt that the overall quality of management in the PCTs is poor. Just one thing to consider though. When reports come out slating general practice or specifically, go forgive, practice management, remember how you or your GPs or staff feel. Morale drops. Just spare a thought for the good managers in the PCTs – and you will have them – who, Canute-like, try to stem the tide of rubbish flowing from the DH and who try to manage their way through poor decisions from their superiors. Try to imagine what morale will be like for these people when this hits their desktops this morning" – Dave Holmes, Lincs
"Practice-based commissioning is back in the frame again. I have commented before about the lack of accountability and public involvement. Paucity of information means that effective management of budgets is difficult and the fact that actual budgets are not available dilutes the level of accountability. Too much emphasis has been placed on the world class commissioning. How can you be a world class commissioner if you are unable to deal with commissioning locally? There are many commissioners available who have the skills to make effective changes, but these are few and far between and it does appear that this is the same story we have been hearing about PBC since its conception. What about local involvement networks? This is another initiative that appears to have been delayed, but in theory is meant to play an integral part in the delivery of local services. As for the GP-led health centres, I think the attitude that 'it is a government directive' does not address whether local views have been taken into account. Does an area really need a new service? Where will patients come from? GPs will be right to be concerned about a reduction in income. The government has already stated that if a patient chooses to register at one of these new centres, then the funding will follow the patient" – Steve Williams, London
"I was present at a meeting in which good money had been spent on a survey of a selected section of the populous – this was for information only and would not be used in the direction it indicated. I can sympathise with the brave decision of Dr Andy Black, when he quit as PEC member and clinical lead for Herefordshire PCT. Since when has it been policy to install untried and untested programs? Costing these enormous figures on unquantified needs, without each and every proposed site be subjected to full scrutiny and with full transparency showing the genuine needs and consequences for the decisions made. Each area selected will be an insula instance and require medical expertise in leading the proposed endeavours down to the smallest minutia" – Denis Walton, West Yorkshire