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PBC 'has not improved services or saved money', report finds

By Gareth Iacobucci

Practice-Based Commissioning has not delivered better services for patients or generated financial savings for the NHS, according to a new report from a leading research body.

An analysis by the King's Fund has revealed that despite GPs being paid nearly £100m in incentives to deliver the scheme uptake in many areas has stalled, and a major-shake of PBC is needed to give GPs more power to deliver the services their patients need.

The report has backed Lord Darzi's call for the Government to persevere with PBC, but claims it will only deliver on its aims if the Government provide national guidance on the future of the policy, devolve responsibility for budgets to GPs and reward high-performing practices with more independence to commission health services.

The detailed study found that progress to date has been slow in all areas, with very few PBC-led initiatives established.

Researchers concluded that there had been ‘little impact in terms of better services for patients or more efficient use of resources', as well as reporting a ‘slight waning in enthusiasm' for PBC between 2007 and 2008.

The report suggested that the main barriers to success were disagreement between GPs and PCTs over their roles and responsibilities; concerns over governance and accountability; and lack of PCT support in equipping GPs with requisite skills and reliable, timely data.

It also cited the difficulty in establishing good working relationships; potential for conflicts of interest and poor quality relations between GPs and the Government as possible reasons for the policy stalling.

It concluded: ‘If the modest gains under PBC are to be built on, there is an urgent need to harness what remains of the limited enthusiasm among GPs.

Little sign that PBC has saved money by bringing more care into the community and away from hospitals

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