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'Embrace PBC or get left behind'

'If the world moves forward and you stand still, you increasingly get left behind.'

These are the words of Sir John Oldham, head of the Improvement Foundation, which focuses on innovative ways of developing primary care. Sir John's message is clear: the writing is on the wall for practice-based commissioning refuseniks.'I would fear for the future of practices who don't in some shape or form get involved,' he warns. 'This is not going to be a fashion that's going to go away. 'When you look at how a Western healthcare system operates it requires not only capacity but also this sort of focused challenge in commissioning.'Sir John feels practice-based commissioning is different from its predecessor, fundholding, because of the way it is 'rooted into local health economies'. 'Myself and my colleagues have in our hands 90 per cent of health expenditure,' he says. 'Without engaging in practice-based commissioning, we in primary care won't have the resources to do what we wish.'Sir John, a GP for nearly 25 years, believes the practice-based commissioning ethos is similar to what motivates GPs to serve their patients. 'It fundamentally allows you to improve services for patients in your practice population,' he says. But he warns: 'We all know the barriers have been lowered for other organisations and companies to come in and deliver primary care.'If we don't grasp this opportunity, others will. Doing nothing is not an option.'Sir John also urges PCTs to act to encourage take-up by making sure the flow of data to practices is presented in a 'meaningful way'. 'A telephone directory of spreadsheets is not meaningful and accessible,' he adds. He predicts that strategic health authorities will begin a 'big push' to make sure that this is happening.Sir John says 68 per cent of practices are involved 'one way or another' in a commissioning consortium. Others are participating, he says, but he estimates about 15 to 20 per cent may still not be involved. 'The trend I see is that there are more consortiums coming together because they see the economy of scale,' he says.And he feels the stasis caused by the reorganisation of trusts is beginning to lift as posts are filled and strategic health authorities start to exert pressure to drive the initiative forward.

Coming of age

Sir John believes practice-based commissioning will finally prove itself in 2008, at the same time as NHS funding growth slows. 'I've always thought that's when it will come into its own simply because of the time lags in terms of the reorganisation,' he predicts.

'What I've been saying to PCTs is your best chance of achieving sustainable financial balance is by engaging GPs.' He adds: 'There's huge potential. If I was giving a tip to people it would be to look at unscheduled admissions. If you look at how to deal with COPD and heart failure properly you can reduce them.'But he warns against aggressive competition between acute trusts and new providers, advocating a strategic approach.'The reality is the best-performing private organisations create long-term relationships with partners of choice. That must be the route to future viability.'He believes one of the reasons why PCT-led commissioning did not always work was because of a lack of understanding of the skills needed for successful commissioning.And he says he is an 'admirer' of South Central SHA, which has hired PriceWaterhouseCoopers to provide support for its commissioners.'There's a need to ensure the skills for commissioning in PCTs are optimised by whatever route,' he says.'South Central has chosen PWC; we are with the NAPC and the Alliance are creating a commissioning course accredited by Tees University.'But practice-based commissioning has created a whole pool of future commissioners who all have their own ideas.This month, Sir John's organisation embarks on a round of workshops, designed to support GPs in every PCT area, and he is hoping the profession will take him up on his offer of help. To date, 2,450 practices have worked with the Improvement Foundation on practice-based commissioning.'We want to do all we can to help practices take advantage of this,' he insists.

hcrump@cmpmedica.com

CVSir John Oldham

• Created the National Primary Care Development Team in 2000, becoming its inaugural head• In 2006 became head of the Improvement Foundation, the NPCDT's successor• Received an OBE in 2000 and in 2006 awarded a knighthood for services to the NHS• A GP since 1983, still undertakes regular clinical sessions, usually two days a week• Also works in education, raising the performance of underperforming pupils

Sir John on...

GPs' involvement in PBC'If we don't grasp this opportunity, others will. Doing nothing is not an option.'TRUSTS'What I've been saying to PCTs is your best chance of achieving sustainable financial balance is by engaging GPs.'The private sector'The reality is the best-performing private organisations create long-term relationships with partners of choice.'

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