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Could a new-look PBC finally catch on?

Practice-based commissioning is not the most catchy of terms, and it has not proved the catchiest of policies either.

Practice-based commissioning is not the most catchy of terms, and it has not proved the catchiest of policies either.

A King's Fund report last week detailed, with some incredulity, just how little GP commissioning has actually happened since the launch of the flagship Government policy, back in 2004. The reasons are depressingly familiar - uncooperative PCTs, bad or non-existent data and an understandable belief among many GPs that it is not their job to organise local health policy.

But the problems with PBC are not confined to the practical. There have also been more fundamental questions over the scheme which have never properly been resolved. The Government's entire health policy, in England at least, has aimed to create a split between commissioners and providers - except for PBC, where the two are frequently muddled up.

Conflicts of interest are not rogue events, and not the fault of individual PBC consortiums, but an almost inevitable consequence of the policy.

Then there is the problem of decommissioning, or rather lack of it. PCTs almost never show the political will to end services, often in secondary care, for which there is no longer a need. Until they do, PBC will simply add on costs without making real savings for the health service.

Pointing out what is wrong with PBC is the easy part. Working out what to do about it is much harder and so far the policy wonks seem stumped. The King's Fund effectively called for an end to GP commissioning, except for the easy stuff, which seems rather defeatist.

The Tories want to tackle the lack of GP engagement in commissioning by simply making it a contractual obligation, which completely fails to tackle the reasons for that lack of enthusiasm.

Closer to the mark

A report published exclusively on Pulse's website this week by Sir John Oldham, former head of the Improvement Foundation and a Government adviser, comes a little closer to the mark.

Sir John is a PBC enthusiast and his report is, naturally enough, fairly upbeat. It has identified a number of practical features of successful PBC programmes - PCTs that provide admin and management support for GPs, and extra incentives for coding checks and adherence to prescribing formularies, and consortiums that set up their own systems for collating data.

Implementing a few of those ideas in every PCT would be a start. Add to that a much clearer definition of the objectives of PBC, guidance about what it is appropriate to commission and who from, and an approach that encourages but does not mandate GP participation, and who knows? It could just catch on.


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