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‘Lack of vision’ still holding back PBC, despite increased commitment

By Gareth Iacobucci

Practice-based commissioning is still being held back by ‘enduring problems', despite increased support and commitment from GPs and NHS bosses, according to a new survey.

A poll by the King's Fund and NHS Alliance reported that commitment to PBC has increased in the past two years, but said the policy remained hamstrung by confusion over roles, low engagement among clinicians, and a lack of clarity over the purpose and vision at a local level.

The survey of GPs, practice managers, PCT bosses, and commissioning managers, found an increase in respondents registering high or very high commitment to PBC, from 73% in 2007, when the organisations carried out a similar survey, to 78% in 2009.

However, whilst there was a very high commitment among PBC managers, the survey reported a more mixed picture from GPs and practice managers.

Financial support and decision making on business cases was rated particularly poorly, with just 31% reporting that they had received and agreed indicative budgets by the Department of Health's May 1 deadline.

Similarly, just 18% said their PCT was making decisions on PBC plans and business cases within a maximum of eight weeks.

However, there was a marked improvement on agreements of budgets and incentives, with 74% having a budget agreed in 2008/09, compared with just 30% in 2007.

The report said ‘significant progress' was still required by PCTs to meet the Department of Health's five entitlements for PBC, as laid out in the recent guidance, with less than half of respondents agreed or strongly agreed that PCTs were meeting them.

However, almost a quarter of respondents said their commitment had increased as a result of the Government's recent reinvigoration document, which reaffirmed that PBC was a national priority.

The report concluded: ‘There continues to be a high level of commitment to the policy among GPs, but many still remain hesitant about its impact to date and unsure if its potential will be fulfilled.

‘Although the Department of Health has gone some way towards developing and promoting a clear vision for PBC at a national level, it is evident that the lack of vision and direction for PBC at a local level is still playing a major part in dampening enthusiasm and engagement.

‘There have been some positive shifts and some progress made since 2007 but it is apparent that certain issues still need urgently addressing.'

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