Tackling data problems in PBC - an introduction
Chris Naylor, health policy researcher at The King’s Fund, outlines current problems with PBC data and the policy developments set to improve things
Chris Naylor, health policy researcher at The King's Fund, outlines current problems with PBC data and the policy developments set to improve things
If PBC is to be reinvigorated, data is a critical issue. Without usable, reliable, up-to-date information on local health needs, referrals and hospital activity, GPs and others are left commissioning in the dark. Our recent research suggests that many practice-based commissioners across the country are in just this situation.
Practice-based commissioners and PCT staff report that a lack of good quality data has been one of the most important barriers accounting for slow progress with PBC.
A number of distinct problems are common.
Data on referrals and hospital activity is often several months old by the time it has been cleaned and made available to GPs.
There have been concerns about the accuracy of hospital activity data and budgetary expenditure data, with some practice-based commissioners finding data provided by PCTs to be at variance with their own practice-level data.
Some practices believe their own data is more up to date and reliable, but commissioning plans based on such data are often not accepted by PCTs.
Limitations on data availability are only part of the problem. Practice-based commissioners also need the right analytical skills to use this data effectively. Some have complained that the training provided when new data systems have been introduced has not been adequate. There is, however, also the question of motivation. In some areas, PCT staff argue that data has been made available and adequate training provided, but that uptake of these systems remains low. This raises the question of how much enthusiasm there is in primary care for developing the necessary skills in data analysis.
Data problems – be they related to the availability of data, or to commissioners' ability or inclination to use it – have hampered PBC in various ways. First, the lack of good quality data has meant that in some cases PCTs have struggled to set and agree ‘fair' indicative budgets with practice-based commissioners – meaning PBC has fallen at the very first hurdle.
Second, a lack of timely data has prevented commissioners from monitoring their performance against budget throughout the year. However, it should be noted that for some purposes data that is not current is still adequate.
Third, data problems seem to have exacerbated PCTs' institutional caution.
PCTs are unwilling to carry the financial risks associated with PBC business cases when these are not supported by robust data analysis – even when commissioning at the PCT level can be based on similarly unscientific practices.
Finally, disputes over data have had an adverse effect on working relations between PCTs and GPs. This partnership is the lynchpin of PBC, without which it is unlikely to succeed.
Although the problems with data in PBC are many, there are a number of policy developments that may help drive improvements. The Department of Health has announced its intention to use the World Class Commissioning assurance framework to hold PCTs to account for the quality of support provided to PBC groups – ‘including the quality and timeliness of data'.
It remains to be seen how powerful a lever this will be. The launch of the PBC development framework, through which commissioners and PCTs can appoint external agencies to provide support services, may also provide a mechanism for improving the availability and use of data at local level.
The most substantial policy input from the DH will come with the release of the PBC reinvigoration guidance, due soon.
It is to be hoped that addressing the data issues highlighted in this magazine forms a central part of the strategy, since it is not only PBC, but commissioning per se, that is dependent on high-quality data analysis.
Chris Naylor is co-author of The King's Fund report Practice-based commissioning. Reinvigorate, replace or abandon? November 2008Tackling data problems in PBC