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DH urged to clarify commissioning roles

The Department of Health is being warned that its new commissioning agenda will become a ‘mess’if it doesn’t clearly spell out the division of responsibilities between practices and PCTs.

By Rebecca Norris

The Department of Health is being warned that its new commissioning agenda will become a ‘mess'if it doesn't clearly spell out the division of responsibilities between practices and PCTs.

he department plans,due to be launched after Practical Commissioning went to press, will require PCTs to become ‘world-class commissioners'.

The aim is to ‘add years to life'of NHS patients and develop skills in leadership,strategy and engagement among clinicians. GPs will play a crucial role, the department's director general of commissioning, Mark Britnell, writes in this issue.

But Dr James Kingsland, chair of the National Association of Primary Care, said that although seeking world-class status was laudable, ‘the question I would ask is,as a commissioner of what?

‘PCTs need to be a world-class commissioner of primary care by looking at the local health needs and inequalities within an area and securing the primary care services to deliver against this agenda – not trying to sort out secondary care commissioning, which is what most of them are still doing at the moment.That is what PBC is supposed to be doing.'

Dr Kingsland added: ‘If PCTs continue to do the same as what PBC is trying to do, then worldclass commissioning will be a mess,with misunderstandings and duplications of roles and responsibilities. We need a clear message.'

Dr Michael Dixon, chair of the NHS Alliance,said he believed initial drafts of the world-class commissioning plans had been changed to make clear that the agenda 'must seamlessly involve PBC'.

‘One of the big problems for practice-based commissioners is that when they have cut referrals,the PCT has been unable to convert this to savings or bring about a redesign at the [acute] trust because the trust seems to be stronger than the commissioner.World-class commissioning should redress that balance and make the PCT stronger. That's good for PBC.'

Dr Dixon said he felt PBC's future had been guaranteed by statements made by Mr Britnell and health secretary Alan Johnson at the NHS Alliance's annual conference in November.‘Both were clear that PBC's the only game in town, and that it's going to go on.'

The Conservatives had also made a commitment to PBC, added Dr Dixon.

But Dr Kingsland said:‘We keep lighting the blue touch paper and it keeps going out because it's damp.We've not seen PBC really take off in the way that October 2004 guidance described.'

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