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Practice-based commissioning failing, says Audit Commission

By Gareth Iacobucci

Practice based-commissioning is failing patients, according to a damning report on the Government's flagship initiative by The Audit Commission.

It says the Government's drive to give GPs greater financial control and responsibility over the services they commission is making limited progress and is being hampered by huge financial and leadership issues.

The Audit Commission visited 16 PCTs and 3 GPs at each PCT to examine local commissioning arrangements, as well as conducting a survey of 122 GPs and practice managers. It also carried out a review of findings from local audit work of PCTs and acute trusts.

It found that ‘engagement of practices was variable', with many ‘unclear how their budgets had been set, or how financial risk was to be managed'.

Few areas were said to have all the factors in place for PBC to succeed.

Steve Bundred, chief executive of the Audit Commission, said: ‘Practice based commissioning offers potential benefits to patients but won't take off unless the NHS gets the financial infrastructure right. Clear and sustained leadership for this policy is also needed if it is to deliver.

‘At the moment patients are losing out because they are not benefiting from the service improvements which practice based commissioning can provide. Our recommendations are designed to help the Department, PCTs and practices achieve that potential.'

The report calls for timely provision of robust budgets which were well understood and accepted by the GP practices which would commission services; regular, accurate and easily understood information which enables GPs to monitor progres, freedom and support for practices to make changes and to generate and use savings for the benefit of their patients and sound governance arrangements for approving business plans and overcoming any potential conflicts of interest when practices use their commissioning budgets to purchase services from themselve.

Dr Michael Dixon, chair of NHS Alliance, claims PBC has ‘the potential to transform the health service' if the Audit Commission's advice is followed. He will tell the NHS Alliance 10th annual conference in Manchester today that PCsT and practice commissioners have been 'blinded by lack of timely, usable information and straitjacketed by national targets.'

GPC chair, Dr Laurence Buckman, said: 'This report highlights what many GPs have unfortunately known for quite a while. PBC has great potential but that potential will never be reached if Primary Care Trusts (PCTs) continue to block initiatives and fail to support practices adequately. '

PCTs and practice-based commissioners have been 'blinded by lack of timely, usable information and straitjacketed by national targets.'

Dr Mike Dixon

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