GPs lose faith in practice based commissioning
By Steve Nowottny
GP confidence in practice-based commissioning has plummeted over the past year, a Pulse survey reveals this week.
Nearly half of GPs said their appetite for PBC had diminished over the period, whereas only one in 10 said it had grown.
The poll of 400 GPs, carried out for Pulse by doctors' mobile communications firm Pearl Medical, identified a catalogue of continuing problems, including PCTs failing to provide practices with useful information, and practices struggling to achieve savings.
Dr James Kingsland, chair of the National Association of Primary Care and a GP in Wirral, described the survey's findings as significant and very worrying and highlighted problems surrounding indicative budgets.
Only 55% of respondents said their PCT had provided them with an indicative budget, and of those who had had one fewer than half said it was easily usable.
Dr Kingsland said: 'By April 2005 it was a requirement for PCTs to devolve an indicative budget no matter how flawed to all practices. You wonder what PCTs have been doing for the past two years.
'Anyone who's commissioning without data isn't commissioning. Without budgetary data PBC is practically impossible.' PCTs were identified by respondents as the principal obstacle to successful commissioning. Seven out of 10 GPs blamed PCTs' financial problems. Lack of enthusiasm from GPs and PCTs alike was also seen as an issue.
Some PCTs have been quick to admit they have struggled to cope. At an NHS Alliance conference in April, the chair of one PCT told GPs it had 'failed appallingly', and was 'still financially flawed'.
Senior NHS sources admit the situation has got no better since.
Dr Alexander Williams, a GP in Exeter, said his practice had yet to receive its savings for 2005/6 from the cash-strapped Devon PCT.
'You have to fight tooth and nail to get any money out of them,' he said. 'They keep putting up barriers and hurdles'
While trusts sort out their financial chaos, PBC is in danger of being fatally undermined, fear its supporters.
Dr David Jenner, PBC lead for the NHS Alliance and a GP in Cullompton, Devon, said PCTs were largely to blame for the lack of progress on practice-based commissioning.
'I still get a lot of enthusiasm about the principle, and a lot of cynicism about PCTs and SHAs allowing it to happen,' he said.
The survey also showed GPs struggling to achieve savings under practice-based commissioning. Only 14% said their practice had managed to achieve savings and 42% said they had not.Dr Alexander Williams had a tooth and nail fight to get money out of Devon PCT Dr Alexander Williams had a tooth and nail fight to get money out of Devon PCT