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Lord Darzi’s PBC security blanket

NAPC chair Dr James Kingsland on why the Next Stage Review should be well received by practice-based commissioners

NAPC chair Dr James Kingsland on why the Next Stage Review should be well received by practice-based commissioners



If Lord Darzi's Next Stage Review doesn't enable us to deliver practice-based commissioning, nothing will.

It is a seminal strategy document for practice-based commissioners because of the opportunities it offers us.

It fosters innovation and supports entrepreneurialism, strengthens commissioning and extends service provision in the community. It spells out that effective primary and community care services are at the core of high-quality health services and a healthy population.

Could the document have said anything but the above? Possibly. There are still too many detractors within the service who would like to block that programme and prevent practices taking over budgetary control.

The document explains that the challenge now is to address health inequalities and unwarranted variations in access and quality of services.

It lays down the gauntlet to primary care, and general practice in particular, challenging it to expand services and extend care in the community, deliver excellent quality and eliminate unacceptable variations.

This document gives us the tools to do what we need to do in practice-based commissioning. The strategy that accompanies it aims to invest resource in success, build on what is already good and sets out how good can become excellent.

There is no new policy in the document about practice-based commissioning, but it shores up what we were promised four years ago in policy documents at the start of the PBC journey. And in that sense it is something of a security blanket for PBC.

However, there are some key points that have not been picked up by the general media as yet.

For example, integrated care organisations are a natural progression of PBC because you can only be an ICO if you have a registered list and you can only have that if you have a contract to provide general practice services. PBC is where it's at in terms of ICOs.

It also talks about our ‘entitlement' to data, budgets and a management allowance as part of business cases to cover things such as contracting in business expertise and paying for clinical time.

Notably, it does not talk about ‘real' budgets. Over the past months it became clear to us that the DH wanted the document to be public-facing, and with that came a change in the language, a dilution of some technical issues, and one of the things that was lost was about the ‘hardening' of budgets.

However, we certainly expect hard cash budgets to be included in some of the demonstration sites for ICOs.

It has been recognised that in the past 10 years, clinicians have not always felt empowered within the NHS. This strategy sets out how this will be dealt with, offering real opportunities to transform services.

The strategy builds on the strength of our current system and will not introduce change for change's sake. Only last year, the Picker Institute identified that only

3% of patients were unsatisfied with their general practice and in the latest Healthcare Commission survey, 75% were satisfied that when visiting their surgery their problem had been expertly dealt with, confirming the value of our registered list system.

This is a good time to be in general practice.

Dr James Kingsland is a GP in Wallasey and chair of the National Association of Primary Care

Dr James Kingsland, chair of the NAPC

There is no new policy about PBC but it shores up what we were promised four years ago.

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