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Eight keys to PBC success

Sir John Oldham, who recently completed a DH survey of the most successful PBC sites, argues that PBC needs to expand as the credit crunch bites

Sir John Oldham, who recently completed a DH survey of the most successful PBC sites, argues that PBC needs to expand as the credit crunch bites

PBC is at a crossroads. In the past two years there has been considerable progress in a number of geographies, some spectacularly so.

It is also the case that there are more functioning PBC consortiums than 12 months ago, but they remain too few islands in a sea of apathy.

The apathy has been multilateral. Many GPs feel they earn a good living and that the hassle of PBC may not be worth it – and this attitude is reinforced when initial enthusiasm has been lost to PCT inertia. In some areas this PCT inertia has derived from a non-belief in PBC as a mechanism, or reluctance to cede perceived (though not real) power, compounded by a deficit in technical skills.

I say this not as criticism but as acknowledgement of tough and pressured jobs, with constant juggling of priorities and PBC often losing out. Yet effective PBC is needed now more than ever. The credit crunch and bank bailouts inevitably impact on NHS resources. Higher unemployment will impact on demand for services.

As clinicians, our priority is the patient we are dealing with and seeking to assist and maximise the care they receive. However, it is naive to believe that we can operate in a vacuum when our writing hand costs NHS resources, both human and fiscal. In fact getting involved in that resource use and using our coalface knowledge to identify better ways of delivering care that is more effective and efficient for the NHS is part of the advocacy role we have always had for patients.

It is also naive to believe that PCT commissioning can occur effectively in a managerial vacuum without meaningful data analysis and genuine involvement of the main drivers of resource use – clinicians. The reality is that in times of resource constraint, maximising the use of resources, redesigning services, sensitising services to communities and eliminating duplications are the ways we can maintain and enhance the care we give to patients.

So what is the way forward? I recently undertook a survey for the Department of Health of the most successful PBC sites around the country. There were eight identifiable common features:

1 Visible supportive PCT leadership

2 Clarity about roles between PBC and PCT

3 Monthly, accurate, timely comparative data at practice level

4 Locality structure within a PCT or within large consortiums

5 Management support by the PCT – this was a high leverage factor

6 Management allowance for consortiums – the amount was per capita based and the median was £2.50 per head of population

7 Incentive schemes – LES and so on

8 Meaningful involvement in PCT commissioning decisions.

The DH has also announced a PBC framework of national assistance for PCTs from validated suppliers (I need to declare an interest as my own organisation in partnership with Tribal is one such supplier). The aim is to help both PBC groups and PCTs improve delivery to patients from PBC.

PBC success depends on knowing where you are and getting the relationships right as well as the technical skills, and that is a whole other article.

Sir John Oldham is former head of the Improvement Foundation. He now runs consultancy Quest4Quality and is a member of the DH's PBC Implementation Team. Our diarist, Dr Peter Weaving, is away this month

PBC success depends on knowing where you are and getting the relationships right Sir John Oldham: believes 2009 is a crunch year for PBC

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