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'Hospital staff should take on PBC' says Darzi

By Nigel Praities

Practice-based commissioning is to be extended to cover hospital staff in a move that may intensify the competition for funding between primary and secondary care.

Under the plans, revealed to Pulse in an exclusive interview with health minister Lord Darzi, hospital trusts will be encouraged to buy in services under PBC.

Consultants, hospital nurses and allied health professionals – including physiotherapists and midwives – will be given the opportunity to reorganise healthcare services and develop proposals for new income streams.

Lord Darzi, speaking to Pulse on the anniversary of his NHS Next Stage Review, said widening out commissioning powers was now seen as a more effective way of driving improvements than setting a new array of central targets.

But PBC leaders warned the plan risked further undermining GP engagement in PBC, and could divert money into hospitals' coffers.

The plans are due to be formally unveiled this week, when the Department of Health publishes a progress report on the first year since publication of the Next Stage Review.

Lord Darzi told Pulse: ‘We will be giving nurses and hospital doctors more control over their budgets. I have always incurred the biggest cost for the organisation I work for and I think I could actually use that resource better if I have it in my own hands.

‘We have seen evidence of that in primary care, and we want to use the same model in the acute sector for nurses, allied health professionals and doctors.'

A move to extend PBC has been mooted before, with rumours of a change of name to ‘Clinicians in Commissioning' circulating earlier this year.

The Government earlier this month included four nurses among the network of ‘clinical champions' to reinvigorate PBC and encouraged midwives to also take a greater role.

But NHS Alliance chair Dr Michael Dixon warned the latest plans risked forcing GPs into competition with powerful foundation trusts – resulting in more resources being diverted away from primary care.

‘If secondary care specialists become more involved in budgets and costs at a foundation trust, what we have is a recipe for people running their budgets in order to keep their own departments going, rather than doing the best for their patients,' he said.

Dr James Kingsland, president of the NAPC and lead for the National PBC Clinical Network, said it was premature to introduce the idea at this stage.

He told Pulse: ‘If we haven't got the GP community widely engaged in PBC, then saying we are going to get community nursing and allied health professions having their own budgets just isn't real. The main focus is to get GP as a unit managing budgets better.'

Darzi on Darzi

On the anniversary of his review…

I am very proud of the fact, that it wasn't just the process of creating the Next Stage Review, but how people have taken their own visions and made it happen locally.

On quality…

Quality is becoming the word that is capturing the imagination of many clinicians. It has revitalised our professionalism.

On access…

I want to thank all GP colleagues for doing such a massive job on improving access in the last year. They have done a fantastic job.

On targets…

We have hit the targets and we now have them as standards. GPs or a consultants are much more ambitious than any of the targets we have set. If you allow them to exercise that ambition and make that happen you give them more power.

On GP-led health-centres getting more money per patient…

I am a minister – I don't do money – so you had better ask the PCTs about that, but I can't see why that should be the case.

On engaging GPs…

We called out for the National Leadership Council and I have concerns because there was no much interest from primary care. I have spoken to Professor Steve Field about this. The solution is in the GP's mind.

Health minister Lord Darzi Health minister Lord Darzi Lord Darzi

We will be giving nurses and hospital doctors more control over their budgets

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