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Darzi report is small on detail, big on PBC

The Darzi report may contain only two paragraphs specifically on PBC, but it is good news for commissioners, says Dr Dinah Roy

The Darzi report may contain only two paragraphs specifically on PBC, but it is good news for commissioners, says Dr Dinah Roy

I returned after a recent break to find my computer about to spontaneously combust, my inbox jammed with copies of Lord Darzi's final report on the future of the NHS and an invitation to its 60th birthday.

The report, High Quality Care for All, is the culmination of a year's activity, building on clinically led workstreams in each SHA area, to describe a vision and implementation plans for a 21st-century NHS.

There are two brief paragraphs in the 92 pages of this report that refer specifically to PBC, which is at first glance disappointing.

It acknowledges that PBC has failed in its purpose and promises to redefine and reinvigorate it and give stronger support – by incentivising broader clinical involvement and bringing GP and hospital specialists together to develop more integrated care.

Interestingly, there is a commitment to clarify the separate processes involved in commissioning and providing services for GP practice populations. PCTs will be held ‘fully' to account for quality of PBC support, including finance and activity data.

In reality, many PBC groups are struggling to keep practices on board.

The amount of work required often feels disproportionate to the benefits achieved, analytical tools are underdeveloped and meetings are frequently dominated by frustration at bureaucratic barriers to progress.

In this context, the report only scratches the surface in providing solutions.

Yes, of course we want PCTs to be effectively held to account for proper support. Yes, we need to incentivise clinical ownership and leadership of service development. However, there are more questions raised than answered here.

At the crossroads?

Given the report's clear steer to broaden the range of clinicians participating in service design, crossing organisational boundaries and focusing on integrated care, plus the promise to ‘redefine' PBC and draw a line between commissioning and providing,

a questions arises. Are we at a crossroads where PBC could be moved away from practices to the control of multiprofessional service redesign groups? If so, does this matter?

Broader clinical involvement is undoubtedly an important factor in effective service redesign but, critically, unless GPs themselves are involved in PBC we will be throwing the baby out with the bathwater.

This is inevitable unless specific, effective incentives for GP participation are agreed – including ‘proper' budgets and autonomous decision-making. Is PBC destined to fizzle out after all?

Not at all – the clue lies in a paragraph challenging the capability of PCTs to become world-class commissioners, including specifically ‘how far we have got with PBC'.

Those PCTs successfully improving health outcomes will be granted greater freedoms to set priorities and choose ways of working, including possibly developing PBC into integrated care organisations.

Darzi clearly expects PCTs to deliver PBC. PCTs should be more focused than ever on developing the right incentive framework and we have opportunities now to lead that debate.

In turn, we must seize the initiative and show PCTs that, with the right tools and freedoms, there are few limits to what can be achieved if we truly take PBC to the edge.

Dr Dinah Roy is chair of Sedgefield PBC group

Dr Dinah Roy - the Darzi report is good for PBC

Specific, effective incentives for GP participation must be agreed - including 'proper' budgets.

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