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Exposed:Best and Worst PBC Supporters

For the first time, the Department of Health has provided information exposing regional variations in the level of support PCTs give practices on PBC. Rebecca Norris presents the headlines

For the first time, the Department of Health has provided information exposing regional variations in the level of support PCTs give practices on PBC. Rebecca Norris presents the headlines

As revealed by Practical Commissioning in our last issue (December 2007), the Department of Health has kept its word to provide more detail on which PCTs are – and are not – supporting practices over the implementation of PBC.

Wave 2 results published last month from the DH's ongoing national survey of practices go further than first-wave findings in several ways. Whereas the first results contained national average findings on the 17 questions, the second-wave statistics include every individual PCT's findings as well as a response from each strategic health authority about their region's performance and any action to be taken as a result.

The way SHAs responded provides as many clues to the attitudes of senior health managers on PBC and GPs as practices' responses do. The length of responses ranged from the brief (the South-West did it in less than a page – a feat achieved by omitting details of negative results) to the detailed (10 pages of PCT-by-PCT breakdown from South-East Coast) to the non-existent, in the case of the London and East Midlands reports. We are told their responses will be added ‘shortly'.

A varied response

The tone of SHA responses also varies from defensive to frank. Yorkshire and the Humber is concerned the sample of practices surveyed was too small (in some cases less than 10% of a PCT) to be representative. It says some respondents wrongly claimed (possibly because ‘they did not understand the question') they had not received an incentive scheme or indicative budgets, when PCTs could prove they gave these to all practices.

Lots of ‘don't know' responses could be from practices only passively engaged in PBC, who rely on more engaged colleagues, the SHA adds. It calls for future surveys to reframe questions to ask ‘have you or has your consortium…?', in order to gain ‘a more accurate picture'.

Some SHAs reveal they conducted their own local surveys or invited PCT self-assessments to compare with the survey data. They include South Central, whose PCTs had a higher opinion of their own performance than practices did – or in SHA speak, ‘a continuing mismatch in understanding and expectation'.

The North-West wears its heart on its sleeve when describing its ‘disappointment' there has not been a greater improvement in the last quarter's scores. It admits PBC varies across the region from being ‘integrated into the core PCT commissioning function' to pockets where it ‘is still being treated as a stand-alone project'.

The SHA also warns: ‘A major concern, nationally and locally, continues to be PBC engagement with the public and the seemingly complete lack of progress should be of concern throughout the whole system.'

Finally, there are interesting differences in the action SHAs now plan to take. Some seem vague – such as the North-East's statement that PCTs ‘have provided assurance they have measures to address improvement'.

Some regions are planning in-depth performance management of low-scoring PCTs, and others list PCTs' specific promises to improve matters by rolling out new data systems, sending out monthly newsletters, recruiting new staff or even creating new primary care development directorates.

A DH spokesperson says the process of SHA reporting will improve for the next survey round. ‘The survey results do vary region by region, however the overall picture is an improving one.'

SHA concerns about survey methodology went hand in hand with SHA recognition that the data was a ‘useful catalyst for change'.

What are your PCT's results?

Our table below offers just a snapshot of each region's performance, but full results can be found on the Department of Health's website

Future issues of Practical Commissioning will report results of the remaining 11 survey waves. Ipsos MORI, working for the DH, is surveying at least 25% of England's practices in each wave.

PCT support on PBC PCT support on PBC


High - 78% of practices feel they have a strong relationship with their PCT, compared with 74% nationally
Low - Only four in 10 said some of their business cases had been approved, compared with 51% nationally
Action - The SHA will work with PCTs to ensure a greater level of emphasis is placed on the challenge of making PBC-led commissioning a reality

West Midlands

High - Higher percentage than national average of practices who rate the quality of managerial support from their PCT as good
Low - A worrying percentage of respondents in each PCT did not know whether a financial incentive scheme was in place or not
Action - SHA to ask low-scoring PCTs to explain their performance in more detail


High 72% of practices report having an indicative budget compared to 57% previously
Low PCTs not seen to be using PBC as a principal means of fostering clinical engagement and leadership
Action SHA will agree action plans with PCTs to improve performance

South Central

High Improvement in the number of practices who have been given an indicative budget
Low All but two PCTs were rated as poor on the quality of managerial support they provided for PBC
Action The SHA's PBC leads
group will be expected to facilitate sharing of good practice with underperforming PCTs


High Practices rate PCT PBC data provision of a higher quality than the national average
Low Practices believe PCTs do not have effective PBC governance arrangements
Action PCTs have acknowledged shortfalls and assured the SHA they have measures in place to address improvements

Yorkshire and the Humber

High The number of practices describing a good relationship with their PCT is higher than the national average
Low Practice ratings on PBC-related outcomes or changes in services compare less favourably to the national average
Action PCTs with below average scores will be the focus of SHA attention

East Midlands

Report not yet published by DH

East of England

High The number of practices reporting new services commissioned as a result of PBC has risen from 21% to 37% across the region
Low Practices increasingly cynical that PBC will free up resources (up to 65% from 63%)
Action Because of responses overall being less positive than the national average, the SHA is requiring PCTs to report on PBC as part of their quarterly performance reviews


Report not yet published by the DH

South-East coast

High Practices in one PCT are signed up to an incentive scheme whose part one alone is worth more than that offered by both parts of the previous national incentive scheme.
Low One PCT will only give practices savings if they are planned rather than fortuitous
Action New system (SOLLIS) being rolled out to practices to improve PBC data quality

Strategic health authorities

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