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PBC failing as GPs go for 'easy wins'

By Gareth Iacobucci

Practice-based commissioning is failing to improve patient care because under-resourced GPs are aiming for easy financial wins rather than targeting local needs, experts claimed this week.

Statistics obtained by Pulse from the NHS PBC Tracker survey show GP commissioning tracks closely with availability of GPSIs, but appears not to address many of the areas targeted by the Government.

Dermatology was by far the most commonly commissioned service in the second quarter of 2007, with the number of clusters commissioning services in the sector more than doubling in the first half of the year.

But NAPC chair Dr James Kingsland, a GP in Wallasey, Merseyside, questioned whether it reflected the aims of PBC.

‘The question is, are areas such as dermatology being chosen because they are low-hanging fruit – the types of conditions general practice sees a lot of and thinks, "there is probably an easy way to redesign that"? That shouldn't be the catalyst for practice-based commissioning.'

The Government white paper launching PBC outlined six health sectors where it could improve services: urology, dermatology, rheumatology, ENT, general surgery and gynaecology.

But dermatology was the only one of these to appear in the top five most commissioned services.

And Dr Kingsland added: ‘With dermatology, it's not much other than shifting the same work into a different venue. It doesn't feel like PBC.'

Dr David Jenner, PBC lead for the NHS Alliance and a GP in Cullompton, Devon, warned that in most parts of the country, PBC was ‘not achieving its aims'.

‘In a very small number of cases, practice-based commissioning is achieving what it set out to,' he said. ‘But in breadth across the country? No.

‘Practice-based commissioning was supposed to drive local priorities.'

Dr Jenner said the onus was on ministers to make PBC a priority on an equivalent level to 18-week waiting lists and access, ‘whereby failing to develop it could be career-damaging for a PCT chief executive'.

But Dr Lisa Silver, a GP in Nettlebed, Oxfordshire, said GPs were not being given the resources to commission effectively.

She said: ‘GPs are saying, "Which is the easy way? If we can make an immediate saving, then why ever not?"

‘Until PCTs say GPs can have up-front monies for these services, nothing's going to run with PBC.'

A Pulse survey last month found more than half of GPs had lost faith in PBC, with many blaming a lack of support from PCTs.

A Department of Health spokesperson said there were no targets in terms of the range of medical conditions to be commissioned under PBC as it was giving GPs the freedom to ‘lead service changes in response to local needs, rather than working towards a prescribed list'.

But she admitted that, in many areas, PBC has ‘focused on services such as dermatology as these are relatively straightforward to redesign'.

Dr Lisa Silver: lack of incentive for GPs to 'make PBC happen' as planned Dr Lisa Silver: lack of incentive for GPs to 'make PBC happen' as planned

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