Slow decision making by trusts impedes progress in practice based commissioning

BMJ 2010; 341 doi: (Published 01 July 2010) Cite this as: BMJ 2010;341:c3545
  1. Adrian O’Dowd
  1. 1London

    Primary care trusts are still too slow to make decisions on proposals made by doctor led practice based commissioning groups, despite improved cooperation between them, a survey has shown.

    Figures from the survey published by the Department of Health show that only 29% of people leading commissioning groups rated the speed of trusts’ decisions on proposals they put forward as being good, and more than one quarter considered that the quality of feedback was poor.

    The BMA has described the statistics as “lamentable” and “disappointing” given that practice based commissioning has been in place since 2005.

    The Practice based commissioning—group and independent leads survey: wave 3 results were based on 483 responses from lead individuals in commissioning groups and practices in England to a survey commissioned by the Department of Health. It is the third wave of research on practice based commissioning, and was conducted between 4 May and 28 May 2010.

    The first wave of this survey was carried out in October last year, with the intention of getting feedback from general practices on their perception of the support offered by their primary care trusts and on the clinical and financial engagement of practices with commissioning.

    The results have been published in advance of a white paper expected from the government in July, which may give GPs real budgets with which to commission.

    In the survey, most leads (86%) said they had a good relationship with their trust in terms of practice based commissioning, but they said trusts were not always good at providing support.

    Just under two thirds of leads (63%) rated the quality of management support as good but only 29% considered the speed of trust decision making for business cases once submitted as good.

    The quality of feedback from trusts on business case decisions was rated as poor by 28% of leads, compared with 37% in the first wave of research six months ago.

    Some benefits of practice based commissioning were apparent in the latest figures, as 86% of leads thought the quality of care available to patients had improved at least a little in terms of better access to services, while 83% thought a better patient experience was being provided.

    Chaand Nagpaul, lead negotiator on commissioning for the BMA’s GP committee, was unimpressed with the results, saying, “These statistics are very disappointing. Practice based commissioning has been patchy and has not been universally successful.”

    The fact that only 63% of commissioning leads rated the quality of management support as good was “lamentable”, according to Dr Nagpaul who thought the figure should be much higher.

    “The fact that after five years of practice based commissioning, around one in three areas have reported that a PCT’s [primary care trust’s] support is inadequate, is unsatisfactory and lamentable,” he said.

    Judith Smith, policy manager at the Nuffield Trust, a health policy think tank, said, “We said in a recent publication that practice based commissioning has not packed the punch we might have hoped for. After five years, one would expect the overall picture of the results would be more positive.

    “If we are moving into a period where GP commissioning is going to form a major plank of government policy, then there are a lot of challenges to be met. We are starting from a relatively fragile base.”


    Cite this as: BMJ 2010;341:c3545