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Commissioning challenge laid bare as analysis reveals PBC cost £250m more than it saved

By Gareth Iacobucci

Exclusive: The huge challenge GPs will face in taking on £80bn of NHS budget has been laid bare by a Pulse investigation finding practice-based commissioning has cost hundreds of millions more than it has generated in savings.

Our analysis of PBC since its inception in 2005 found GPs will take on budgets on a hugely uneven playing field, depending on whether GP commissioning has become established in the local health economy.

Go-getting GPs in a handful of areas with well-developed commissioning economies have developed numerous services and saved millions of pounds. But in the vast majority of the 100 PCTs that responded to Freedom of Information Act requests, PBC struggled to reshape services and cost far more than it saved.

Across the 100 trusts, £290m was spent on PBC since its launch in 2005 – on managerial support, data management, incentive payments and support from private companies – yet only £133m was saved. Extrapolated across the 152 PCTs in England, PBC was likely to have cost £441m and saved £198m – a deficit of £243m.

Our investigation underlines the size of the task that will be handed to GP consortiums in England, following the planned abolition of SHAs in 2012 and PCTs in 2013.

The findings are likely to alarm many GPs, as the Department of Health plans to tie a proportion of practice pay to the ability of consortiums to stay within budget.

They may also fuel the belief among many GPs that the DH should not have pushed ahead with its commissioning plans without piloting first.

Health secretary Andrew Lansley cited the success of some PBC groups as evidence of GPs' readiness to take the commissioning reins. Our investigation found a substantial 2,328 services nationwide were developed or re-designed through PBC, but many were concentrated in just a few areas where GP commissioning was a success.

GPs in NHS Telford, NHS Bradford and Airedale and NHS City and Hackney together commissioned more than 800 new services, and delivered £3.9m, £20.2m and £6.5m in savings respectively.

GPs in NHS Northamptonshire and NHS Nottingham City – both highlighted by primary care tsar Dr David Colin-Thomé in an interview with Pulse this week – saved £12.7m and £2.5m respectively in tandem with significant service redesign.

But the overall picture was far less positive, with 83% of trusts unable to demonstrate any savings, and many struggling to commission new services. NHS Luton and NHS Blackburn with Darwen have spent £1.6m and £2.1m respectively on PBC since its launch, but made no savings and commissioned no services.

Dr Johnny Marshall, chair of the National Association of Primary Care and a GP in Wendover, Buckinghamshire, said Pulse's investigation demonstrated fundamental lessons needed to be learned from PBC.

‘Many of the barriers are about relationships, and it's important we address those obstacles from the start. It's encouraging that the areas with greatest engagement brought the most significant service changes.'

Dr Neil Shroff, a GP in Nottingham, said PBC within NHS Nottinghamshire County had stalled, with his skin cancer surgery service recently closed over cost concerns after changes to the tariff. ‘Hopefully there will now be less bureaucracy and more encouragement,' he said.

David Stout, head of the NHS Confederation's PCT Network, acknowledged some PCTs had failed to support PBC, but said some GPs ‘didn't engage or motivate themselves': ‘The scope of PBC hasn't been realised. The theory is that giving GPs much more profound responsibilities means they will have to take commissioning seriously.'

A DH spokesperson insisted GP commissioning was essential to deliver improved outcomes: ‘GPs are in the best possible position to know what services their communities need.'

More on...

All the latest on the Government's plans for GP commissioning.

Dr Neil Shroff: his skin surgery service commissioned under PBC has closed due to cost pressures Google map of PBC spend in your area

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