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Kick-starting PBC: An introduction

NAPC chair Dr Johnny Marshall sets out how the culture around PBC needs to change.

NAPC chair Dr Johnny Marshall sets out how the culture around PBC needs to change.

Earlier this month, the Government set out its vision for PBC and what PCTs need to do next. The new document Clinical Commissioning: Our Vision For PBC leaves no doubt that PBC is a central Department of Health policy and one that is here to stay.

Its pledges – for PCTs to distribute indicative budgets by 1 May and for an eight-week turnaround for business cases as part of a package of entitlements for PBC – are of course very welcome. But what we also need now is a new style of relationship between PCTs and practices – and this is something beyond any policy or document.

The articles in this Focus on report reflect how important local relationships are. Five of the 10 top tips in the article on kicking PBC into action are about harnessing relationships. The Salford example shows what needed to happen for one PBC group to be taken seriously by its PCT and acute trust. The business plan article also illustrates how you cannot work in isolation in developing your PBC model but need to know the priorities for your PCT.

The relationship change that needs to happen between PBC groups and PCTs has to be a two-way thing. In short, PCTs need to delegate authority to practice-based commissioners and practice-based commissioners need to accept the greater accountability this will require.

We need a culture of innovation and measured risk-taking within the PCT, where clinicians are given real influence – and therefore power – in the commissioning process, in partnership with managerial colleagues as part of a commissioning team. Engagement in PBC will be achieved through PCTs leading through empowerment, enablement and delegation.

World Class Commissioning should help push this relationship change along.

It is incumbent on PCTs to demonstrate their commitment to PBC through the compilation of development plans. These should document the development needs and resources required to support effective PBC locally, what support the PCT can currently provide and how the trust intends to close the identified gap.

Should they fail to deliver against this plan in a declared timely fashion, alternative action would need to be taken, such as procuring the support from elsewhere to do this. It is time PCTs saw practice-based commissioners as ‘customers' in this respect.

And how do practice-based commissioners need to change?

The greater accountability required needs to be at practice level and ultimately individual clinician level – in terms of how care is delivered with regard to both quality and value for money. By combining their efforts through collaboration between practices, commissioners' external sphere

of influence is likely to grow, but this should not be at the cost of losing accountability and leadership at a practice level.

They will also need to make a clinical contribution to commissioning at a more strategic level across a wider population than their practice or PBC collaborative base. By showing their worth as both commissioners and providers, practice-based commissioners will demonstrate they warrant the investment that is being made in them.

The need for PBC is as strong as ever, given the greater pressure there will be over the coming years to deliver more value for every taxpayers' pound.

If practice-based commissioners can provide the clinical leadership that PCTs require, and PCTs are prepared to take the risk that such innovation requires, then the pace of change will be limited only by our imagination.

Dr Johnny Marshall is chair of the NAPC

Want to know more about how to enhance PCT relations?

This is just one of the topics that will be covered at our forthcoming one-day conference, PBC: Making It Happen, on 4 June 2009 in central London.

Practical Commissioning, in association with Pulse, has developed a programme that will empower delegates to drive PBC forward in their area. To view the full agenda and to register, call 020 7921 8039 or click here to visit

Kick-starting PBC

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