Practice based commissioning is “here to stay,” government says

The Department of Health has insisted that practice based commissioning is “here to stay,” despite continuing evidence that many GPs in England remain reluctant to take part.

The latest quarterly MORI survey of GPs shows that 73% have now received a practice based budget, 67% have agreed a commissioning plan, and 56% are commissioning services. But support for the policy has actually fallen slightly, from 64% in the last survey to 62% now.

Speaking at the launch of the health department’s new “vision” for practice based commissioning, the national clinical director for primary care, David Colin-Thome, admitted that the approach was “sporadic rather than embedded in the system.”

But, he said, practice based commissioning was “very much here to stay.” It was crucial to achieving better value for money, driving improvement, and ensuring that clinicians played a central role in shaping health and health care.

He outlined a series of new “entitlements” for all practice based commissioners that would address shortcomings in the quality and speed of data provided by primary care trusts and the slow turnaround of practice plans and business cases. They include “accurate and timely” data and analysis on budgets, spending, referrals prescribing, activity and, where possible, clinical performance, together with a package of management and financial support. In addition, every practice would receive its indicative budget and know the level of its support package by 1 May each year.

The department’s practice based commissioning development team would be visiting all regions this spring to offer support and learn about barriers to progress, he added. The MORI survey would be used as a “heat map” to identify where extra support was needed.

He rejected claims that GPs who commissioned and also provided services were facing a conflict of interest. But he indicated that external tendering for services should be a “minority pastime.”

Johnny Marshall, chairman of the National Association of Primary Care, suggested that the MORI survey exaggerated the level of support for practice based commissioning. “Those figures look very high to me,” he said. “I think we still need to go some way to turn this process into a reality.” If practice based commissioning were to work, he said, trusts and GPs would have to challenge the status quo. GPs needed to “face up to and challenge some of our own behaviour, how we use resources, and how we set up our practice.”

Nick Goodwin, senior fellow at the health think tank the King’s Fund, said that many GPs were still holding back because of a perceived lack of professionalism and support at the level of primary care trusts. Until now practice based commissioning had been a “bit of a minority sport for enthusiastic amateurs and heroes,” he said. Many GPs were “watching the match but not really taking part.”