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GPs backing PBC but still hitting hurdles

A stronger positive feeling towards PBC is developing among GPs, but recurring barriers continue to hamper progress, according to a major new survey.

The report PBC Two Years On: Moving Forward and Making a Difference? from the NHS Alliance and the King's Fund is a follow-up to a survey carried out in 2007, which found the percentage of respondents saying they had a ‘very high' or ‘high' commitment to PBC was 73% whereas those describing their commitment as ‘low' or ‘very low' was 27%.

These figures for 2009 changed to 78% and 22% respectively.

Some 321 responses to the survey were received, covering 95 different PCTs with 45% of respondents being GPs, 26% practice managers and 19% PBC managers and 10% ‘other'.

The most frequently cited reason for increased commitment was the publication of Clinical Commissioning: Our Vision for Practice-based Commissioning for making it clear that PBC is a national priority.

However, alongside such positive changes, the PBC basics appear to still be missing in many areas.

Less than 50% of respondents agreed their PCT was delivering their five PBC entitlements – quality data, management support, indicative budgets by

1 May, business plan decisions within eight weeks and effective PBC incentive schemes.

Very few respondents directly called for PBC to be abandoned as a policy.

Dr Mike Dixon, NHS Alliance chair, said the report implied that while there was a lot of PBC going on, much was small-scale.

‘We still have very few PBC consortiums that have a real hold on the budget and are doing something in terms of radical redesign.

‘It seems to be PBC on sufferance by PCTs who are happy to devolve a bit, but full devolution and full trust in PBC is still quite a rarity.'

Other notable findings in the survey

• Only 43% of respondents had an agreed budget for 2009/10 by mid-May 2009

• An improvement on freed-up resources was reported, with 42% saying they expect to retain 70% of savings, compared with 19% two years ago

• 22% felt PBC was a very high priority for their PCT and a further 42% thought it was a high priority

• Of the clinicians who responded, 52% said they still did not feel very engaged by their PCT at a local level

• Almost two-thirds reported that there was a PCT management budget in place to support PBC – the largest proportion was the 39% who said they receive between £1 and £2 per patient

• 21% of budgets were at fair shares for 2009/10 compared with 7% in 2008/9

• Historical activity as the basis for budgets fell from 33% to only 12%

• The survey also found a more formalised approach being taken to PBC with large clusters prevailing – some 57% of respondents said their PBC budget was held at a cluster level rather than at their own practice

• 40% said there was an agreement in place in their PCT as to how conflicts of interest were to be managed

• 45% said PBC would help improve patient care over the next two years ‘a little', and a further 27% said it would improve it ‘a great deal'

• Almost half of all business cases took a year from submission to service change actually taking place

Still feeling of PBC on sufferance among PCTs Dr Mike Dixon

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